Provider Demographics
NPI:1962225656
Name:KALAITSIDES, ADRIENNE R
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:R
Last Name:KALAITSIDES
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 1:900 LAUREL GREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-9812
Mailing Address - Country:US
Mailing Address - Phone:330-575-3902
Mailing Address - Fax:
Practice Address - Street 1:900 LAUREL GREEN DR NE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-9812
Practice Address - Country:US
Practice Address - Phone:330-575-3902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide