Healthcare Provider Details

I. General information

NPI: 1205891371
Provider Name (Legal Business Name): MICHELLE KUSIC CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST SUITE B1
AKRON OH
44304-1429
US

IV. Provider business mailing address

525 E MARKET ST ANNEX 3
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-4844
  • Fax: 330-375-4067
Mailing address:
  • Phone: 330-375-7512
  • Fax: 330-375-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP-01184
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: