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General NPI Number Information
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NPI Number | 1437969201
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Entity Type | Organization
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Legal Business Name | KSN PRIMARY CARE LLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1841 FAIRLAWN KNOLLS DR
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City | AKRON
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State | OH
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Zip | 44313-5435
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Country | US
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Telephone | 330-310-6812
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Fax | 330-776-5557
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Provider Business Mailing Address
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Address Line | 1841 FAIRLAWN KNOLLS DR
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City | AKRON
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State | OH
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Zip | 44313-5435
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Country | US
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Telephone | 330-310-6812
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KORTO SULONGTEH-NELSON
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Credential |
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Telephone | 330-310-6812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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