Provider Demographics
NPI:1992538532
Name:RANTTILA, KIRSTEN ALEXA (STNA)
Entity type:Individual
Prefix:MISS
First Name:KIRSTEN
Middle Name:ALEXA
Last Name:RANTTILA
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LOGAN AVE NE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-5839
Mailing Address - Country:US
Mailing Address - Phone:330-442-1904
Mailing Address - Fax:
Practice Address - Street 1:169 LOGAN AVE NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-5839
Practice Address - Country:US
Practice Address - Phone:330-442-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602685351023251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health