Healthcare Provider Details

I. General information

NPI: 1972245082
Provider Name (Legal Business Name): KERSTIN ANN SCHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 04/09/2022
Certification Date: 04/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 WOODSIDE DR
KENT OH
44240-2663
US

IV. Provider business mailing address

641 WOODSIDE DR
KENT OH
44240-2663
US

V. Phone/Fax

Practice location:
  • Phone: 330-554-0938
  • Fax:
Mailing address:
  • Phone: 330-554-0938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: