Provider Demographics
NPI:1063030765
Name:CROMER, KIMBERLY THURZA
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:THURZA
Last Name:CROMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34779 LESLIE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-1746
Mailing Address - Country:US
Mailing Address - Phone:440-452-8599
Mailing Address - Fax:
Practice Address - Street 1:34779 LESLIE AVE
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-1746
Practice Address - Country:US
Practice Address - Phone:440-452-8599
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2020011737363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health