Healthcare Provider Details

I. General information

NPI: 1053914887
Provider Name (Legal Business Name): MRS. MARY R. KRABILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1712 STURBRIDGE DR
LOUISVILLE OH
44641-8790
US

IV. Provider business mailing address

1712 STURBRIDGE DR
LOUISVILLE OH
44641-8790
US

V. Phone/Fax

Practice location:
  • Phone: 330-209-4582
  • Fax: 330-875-0434
Mailing address:
  • Phone: 330-209-4582
  • Fax: 330-875-0434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number2854193
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: