Provider Demographics
NPI:1679530919
Name:HANUSCHOCK, RITA (CNP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:HANUSCHOCK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 GORGE BLVD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2408
Mailing Address - Country:US
Mailing Address - Phone:330-375-7474
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST STE 410
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1433
Practice Address - Country:US
Practice Address - Phone:330-375-7474
Practice Address - Fax:330-375-6129
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN178665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ53202Medicare UPIN
OHHANP79421Medicare PIN