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General NPI Number Information
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NPI Number | 1073952685
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Entity Type | Individual
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Provider Name | GINA MARIE KICOS DNP, APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 06/17/2013
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 4235 TUSCARAWAS ST W
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City | CANTON
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State | OH
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Zip | 44708-5424
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Country | US
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Telephone | 234-203-4232
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Fax | 330-266-4386
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Provider Business Mailing Address
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Address Line | 3721 20TH ST NW
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City | CANTON
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State | OH
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Zip | 44708-2926
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Country | US
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Telephone | 330-354-7324
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.14603
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License Number State | OH
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