Provider Demographics
NPI:1467939371
Name:BUROCK, KRISTEN M (CNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:BUROCK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MERCY DR NW STE 319
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-2624
Mailing Address - Country:US
Mailing Address - Phone:330-471-5936
Mailing Address - Fax:234-203-3561
Practice Address - Street 1:1330 MERCY DR NW STE 319
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708
Practice Address - Country:US
Practice Address - Phone:330-253-1411
Practice Address - Fax:330-253-1720
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.385347163W00000X
OHAPRN.CNP.023450363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0307426Medicaid