Provider Demographics
NPI:1851728679
Name:POULIOT, KRYSTINA LYN (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:LYN
Last Name:POULIOT
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1321
Mailing Address - Country:US
Mailing Address - Phone:330-502-4224
Mailing Address - Fax:
Practice Address - Street 1:2511 BENTLEY DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2503
Practice Address - Country:US
Practice Address - Phone:330-502-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0031937363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care