Healthcare Provider Details

I. General information

NPI: 1699313049
Provider Name (Legal Business Name): TORY ELIZABETH KUTSKO CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 02/22/2021
Certification Date: 02/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2497 STATE ROUTE 59
RAVENNA OH
44266-1641
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-676-1020
  • Fax:
Mailing address:
  • Phone: 330-376-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.025781
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.025781
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: