Provider Demographics
NPI:1336698513
Name:OUELLETTE, KRISTEN (CNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:6505 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3457
Mailing Address - Country:US
Mailing Address - Phone:330-746-9200
Mailing Address - Fax:330-746-9201
Practice Address - Street 1:6505 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3457
Practice Address - Country:US
Practice Address - Phone:330-746-9200
Practice Address - Fax:330-746-9201
Is Sole Proprietor?:No
Enumeration Date:2016-09-28
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.18050363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner