Healthcare Provider Details

I. General information

NPI: 1275243180
Provider Name (Legal Business Name): KATHLYN SUE ZURCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7512 BOLTZ ORCHARD RD SW
STONE CREEK OH
43840-9416
US

IV. Provider business mailing address

7512 BOLTZ ORCHARD RD SW
STONE CREEK OH
43840-9416
US

V. Phone/Fax

Practice location:
  • Phone: 330-204-2885
  • Fax:
Mailing address:
  • Phone: 330-204-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN105059
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: