Provider Demographics
NPI:1932750288
Name:EHRICH, KRISTINA
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:EHRICH
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 1:5141 WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:OH
Mailing Address - Zip Code:44201-9345
Mailing Address - Country:US
Mailing Address - Phone:330-606-3590
Mailing Address - Fax:
Practice Address - Street 1:437 PORTAGE TRL
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-3227
Practice Address - Country:US
Practice Address - Phone:330-929-9136
Practice Address - Fax:330-929-9189
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006171RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant