Healthcare Provider Details

I. General information

NPI: 1467939371
Provider Name (Legal Business Name): KRISTEN M BUROCK CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 02/09/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 MERCY DR NW STE 319
CANTON OH
44708
US

IV. Provider business mailing address

1330 MERCY DR NW STE 319
CANTON OH
44708-2624
US

V. Phone/Fax

Practice location:
  • Phone: 330-253-1411
  • Fax: 330-253-1720
Mailing address:
  • Phone: 330-471-5936
  • Fax: 234-203-3561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.385347
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN.CNP.023450
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: