Provider Demographics
NPI:1851527022
Name:PERUSKO, KRISTY NICOLE (MSN/FAMILY NURSE PRA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:NICOLE
Last Name:PERUSKO
Suffix:
Gender:F
Credentials:MSN/FAMILY NURSE PRA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35000 KAISER CT
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3382
Mailing Address - Country:US
Mailing Address - Phone:440-269-4600
Mailing Address - Fax:
Practice Address - Street 1:6559 WILSON MILLS ROAD
Practice Address - Street 2:106A
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3433
Practice Address - Country:US
Practice Address - Phone:440-449-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2009002660363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily