Provider Demographics
NPI:1144535683
Name:KUMPUS, CHRISTINA R (RN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:R
Last Name:KUMPUS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:R
Other - Last Name:HAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:625 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44702-1805
Mailing Address - Country:US
Mailing Address - Phone:330-455-0374
Mailing Address - Fax:330-455-2101
Practice Address - Street 1:1207 W STATE ST
Practice Address - Street 2:SUITE M
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-8407
Practice Address - Country:US
Practice Address - Phone:330-821-8407
Practice Address - Fax:330-821-8506
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN319942163WC1500X
OH319942163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2098331Medicaid