Healthcare Provider Details

I. General information

NPI: 1972023950
Provider Name (Legal Business Name): KELSEY ANNE NJUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E MARKET ST
AKRON OH
44304-1619
US

IV. Provider business mailing address

2937 SOUREK RD
AKRON OH
44333-2709
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3000
  • Fax:
Mailing address:
  • Phone: 330-858-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.005119RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: