Healthcare Provider Details

I. General information

NPI: 1316769839
Provider Name (Legal Business Name): KARA NICHOLE KUDRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 10/28/2024
Certification Date: 10/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 REDWOOD DR
CUYAHOGA FALLS OH
44223-3000
US

IV. Provider business mailing address

399 REDWOOD DR
CUYAHOGA FALLS OH
44223-3000
US

V. Phone/Fax

Practice location:
  • Phone: 330-612-2199
  • Fax:
Mailing address:
  • Phone: 330-612-2199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License NumberRN467048
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN467048
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: