Provider Demographics
NPI:1114535952
Name:VANNOSTRAN, KIRSTEN (LAC)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:
Last Name:VANNOSTRAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:ERICSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1708 MEMMAN RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313
Mailing Address - Country:US
Mailing Address - Phone:330-929-4334
Mailing Address - Fax:
Practice Address - Street 1:1708 MEMMAN RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313
Practice Address - Country:US
Practice Address - Phone:330-929-4334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH60000037171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist