Provider Demographics
NPI:1619981826
Name:YURICH, KIRSTEN R (CRNA)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:R
Last Name:YURICH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:R
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:1031 W WESTERN RESERVE RD
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3541
Practice Address - Country:US
Practice Address - Phone:330-965-0900
Practice Address - Fax:330-965-9250
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN573878367500000X
OHRN285372367500000X
FLAPRN11011738367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2614620Medicaid
PA1015362870001Medicaid
OH8236253OtherMEDICARE PTAN
PA168268OtherMEDICARE PTAN