Provider Demographics
NPI:1467599472
Name:KRICHBAUM, HEATHER L (CPNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:KRICHBAUM
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:PINKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3360 HARDWOOD HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-9693
Mailing Address - Country:US
Mailing Address - Phone:614-871-8500
Mailing Address - Fax:614-871-4803
Practice Address - Street 1:3360 HARDWOOD RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:419-207-1085
Practice Address - Fax:419-207-0607
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.313822-COA1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics