Provider Demographics
NPI:1700957172
Name:GRUHN, KELLY LYNN (LPN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYNN
Last Name:GRUHN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:LAWRENCE/RHOADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1376 N MEDINA LINE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2503
Mailing Address - Country:US
Mailing Address - Phone:330-819-0907
Mailing Address - Fax:
Practice Address - Street 1:1376 N MEDINA LINE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2503
Practice Address - Country:US
Practice Address - Phone:330-819-0907
Practice Address - Fax:330-723-6297
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN114064164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2487723Medicaid