Provider Demographics
NPI:1730679952
Name:DUVALL, KRISTINE NOELLE
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:NOELLE
Last Name:DUVALL
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 1:2832 AARON DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7970
Mailing Address - Country:US
Mailing Address - Phone:330-321-9924
Mailing Address - Fax:
Practice Address - Street 1:6681 RIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5705
Practice Address - Country:US
Practice Address - Phone:440-842-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.022706363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health