Provider Demographics
NPI:1114555042
Name:SCHUMAN, KRISTINA MCKENZIE
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MCKENZIE
Last Name:SCHUMAN
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 1:1223 W 37TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-2719
Mailing Address - Country:US
Mailing Address - Phone:440-396-5158
Mailing Address - Fax:
Practice Address - Street 1:1223 W 37TH ST
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-2719
Practice Address - Country:US
Practice Address - Phone:440-396-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X
OH4703360372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4703360Medicaid