MEDICARE: NICHOLE RENEE KRAYNICK CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	COA.14876-NP	OH

General Provider Information

NPI Number	:	1033551379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE RENEE KRAYNICK CNP

Provider Business Mailing Address
First Line	:	789 WHITE POND DR STE A
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4203
Country	:	US
Telephone Number	:	330-376-0500
Fax Number	:	330-376-9900

Provider Business Practice Location Address
First Line	:	789 WHITE POND DR STE A
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44320-4203
Country	:	US
Telephone Number	:	330-376-0500
Fax Number	:	330-376-9900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	10/21/2015

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