Provider Demographics
NPI:1437459070
Name:FRUITS, CRISTINE L (PA)
Entity Type:Individual
Prefix:
First Name:CRISTINE
Middle Name:L
Last Name:FRUITS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CRISTINE
Other - Middle Name:L
Other - Last Name:ROZELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:27089 BAGLEY RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1103
Mailing Address - Country:US
Mailing Address - Phone:440-234-4700
Mailing Address - Fax:
Practice Address - Street 1:27089 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:OLMSTED TWP
Practice Address - State:OH
Practice Address - Zip Code:44138-1103
Practice Address - Country:US
Practice Address - Phone:440-234-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50003177146M00000X
OH50.003177RX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate