Provider Demographics
NPI:1730360462
Name:MARETH, KRISTI LYN (PA)
Entity type:Individual
Prefix:
First Name:KRISTI
Middle Name:LYN
Last Name:MARETH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:LYN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # A40
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-7164
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # A40
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1932
Practice Address - Country:US
Practice Address - Phone:216-445-7164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-22
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant