Healthcare Provider Details

I. General information

NPI: 1306143045
Provider Name (Legal Business Name): KATHYRN MARIE WHELLER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHYRN LAFOREST CNP

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 01/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

214 W. BOWERY ST STE 5200
AKRON OH
44308
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8521
  • Fax: 330-543-3850
Mailing address:
  • Phone: 330-543-8030
  • Fax: 330-543-3850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.12056-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: