Healthcare Provider Details

I. General information

NPI: 1902302615
Provider Name (Legal Business Name): DR. KRISTEN A ECHANIQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 10/06/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # A71
CLEVELAND OH
44195-7419
US

IV. Provider business mailing address

9500 EUCLID AVE # A71
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-2792
  • Fax:
Mailing address:
  • Phone: 216-444-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number35.148542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: