Healthcare Provider Details

I. General information

NPI: 1295651354
Provider Name (Legal Business Name): OLIVIA ROSE KROAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 CHIPPEWA AVE NW
NORTH CANTON OH
44720-6722
US

IV. Provider business mailing address

7050 CHIPPEWA AVE NW
NORTH CANTON OH
44720-6722
US

V. Phone/Fax

Practice location:
  • Phone: 330-990-7954
  • Fax:
Mailing address:
  • Phone: 330-990-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010396RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: