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NPI Code Detail

MEDICARE: MRS. KRISTY NICOLE PERUSKO MSN/FAMILY NURSE PRA

MEDICARE: MRS. KRISTY NICOLE PERUSKO MSN/FAMILY NURSE PRA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner2009002660OH

General Provider Information

NPI Number : 1851527022
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTY NICOLE PERUSKO MSN/FAMILY NURSE PRA
Provider Business Mailing Address
First Line : 35000 KAISER CT
Second Line :
City : WILLOUGHBY
State : OH
Zip : 44094-3382
Country : US
Telephone Number : 440-269-4600
Fax Number :
Provider Business Practice Location Address
First Line : 6559 WILSON MILLS ROAD
Second Line : 106A
City : MAYFIELD VILLAGE
State : OH
Zip : 44143-3433
Country : US
Telephone Number : 440-449-1540
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2009
Last Update Date : 10/09/2022

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Directions to “ MRS. KRISTY NICOLE PERUSKO MSN/FAMILY NURSE PRA” Practice Location

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