Healthcare Provider Details

I. General information

NPI: 1063872448
Provider Name (Legal Business Name): KRISTIN MOKAREN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MINERAL SPRINGS ST
ORRVILLE OH
44667-1130
US

IV. Provider business mailing address

4592 COLINAS DR
MEDINA OH
44256-6329
US

V. Phone/Fax

Practice location:
  • Phone: 330-682-1851
  • Fax: 330-682-2143
Mailing address:
  • Phone: 330-321-1501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number258555
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: