Healthcare Provider Details

I. General information

NPI: 1336698513
Provider Name (Legal Business Name): KRISTEN OUELLETTE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTEN ELIZABETH MARTIN CNP

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 MARKET ST
BOARDMAN OH
44512-3457
US

IV. Provider business mailing address

6505 MARKET ST
BOARDMAN OH
44512-3457
US

V. Phone/Fax

Practice location:
  • Phone: 330-746-9200
  • Fax: 330-746-9201
Mailing address:
  • Phone: 330-746-9200
  • Fax: 330-746-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.18050
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: