Provider Demographics
NPI:1265018808
Name:CRUICKSHANK, KATHERINE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:
Last Name:CRUICKSHANK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2777 YOUNGSTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:OH
Mailing Address - Zip Code:44437-1542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2777 YOUNGSTOWN AVE
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:OH
Practice Address - Zip Code:44437-1542
Practice Address - Country:US
Practice Address - Phone:330-502-7588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program