Provider Demographics
NPI:1285739433
Name:KROLL, PAULA KAY (STNA)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:KAY
Last Name:KROLL
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:KAY
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STNA
Mailing Address - Street 1:2128 LEISURE RD NW
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-8835
Mailing Address - Country:US
Mailing Address - Phone:330-771-8241
Mailing Address - Fax:
Practice Address - Street 1:2128 LEISURE RD NW
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657-8835
Practice Address - Country:US
Practice Address - Phone:330-771-8241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH375386470296376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH375386470296OtherSTNA