Provider Demographics
NPI:1659756260
Name:KREITZBURG, LORI (CNP)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:KREITZBURG
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 1:408 DEVON PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6479
Mailing Address - Country:US
Mailing Address - Phone:330-673-6235
Mailing Address - Fax:330-678-8811
Practice Address - Street 1:408 DEVON PL
Practice Address - Street 2:SUITE B
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6479
Practice Address - Country:US
Practice Address - Phone:330-673-6235
Practice Address - Fax:330-678-8811
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-290707-1163W00000X
OHCOA.17631-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse