Healthcare Provider Details

I. General information

NPI: 1467762989
Provider Name (Legal Business Name): KRISTIN G BIDDELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 MENTOR AVE STE 100
MENTOR OH
44060
US

IV. Provider business mailing address

7590 AUBURN ROAD SUITE 014
CONCORD TWP OH
44077-9176
US

V. Phone/Fax

Practice location:
  • Phone: 440-352-4880
  • Fax: 440-352-3629
Mailing address:
  • Phone: 440-354-1899
  • Fax: 440-354-1845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.11890-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: