Healthcare Provider Details

I. General information

NPI: 1487319778
Provider Name (Legal Business Name): ANDI HRUSOVSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 11/02/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9471 MARKET ST STE A
NORTH LIMA OH
44452-8702
US

IV. Provider business mailing address

2059 BEDFORD RD
LOWELLVILLE OH
44436-9753
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-7100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: