Provider Demographics
NPI:1326098757
Name:KAUFMAN, KRISTINE RENEE (CNP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:RENEE
Last Name:KAUFMAN
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 1:1740 N PERRY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OTTAWA
Mailing Address - State:OH
Mailing Address - Zip Code:45875-1173
Mailing Address - Country:US
Mailing Address - Phone:419-523-0012
Mailing Address - Fax:419-523-3416
Practice Address - Street 1:1740 N PERRY ST
Practice Address - Street 2:SUITE A
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1173
Practice Address - Country:US
Practice Address - Phone:419-523-0012
Practice Address - Fax:419-523-3416
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.04561-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2362296Medicaid
OH736264OtherBUCKEYE
OHP00204711OtherRAILROAD CARE
OHP00472602OtherRAILROAD CARE
OH000000348925OtherANTHEM BC/BS
OH000000550636OtherANTHEM BC/BS
OHNP03117Medicare PIN
OHP00204711OtherRAILROAD CARE
OH2362296Medicaid