Provider Demographics
NPI:1689358632
Name:MCCONNON, KRISTA LEE
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEE
Last Name:MCCONNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34154 TOPAZ ST
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-2006
Mailing Address - Country:US
Mailing Address - Phone:440-823-0025
Mailing Address - Fax:
Practice Address - Street 1:34154 TOPAZ ST
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-2006
Practice Address - Country:US
Practice Address - Phone:440-823-0025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide