Provider Demographics
NPI:1275267809
Name:ZEISLOFT, KRISTINE G
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:G
Last Name:ZEISLOFT
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 1:222 E FOREST ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-1215
Mailing Address - Country:US
Mailing Address - Phone:567-644-3220
Mailing Address - Fax:
Practice Address - Street 1:222 E FOREST ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-1215
Practice Address - Country:US
Practice Address - Phone:567-644-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.151919164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse