Provider Demographics
NPI:1407376353
Name:KREUZMANN, JACOB
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:
Last Name:KREUZMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45012-0837
Mailing Address - Country:US
Mailing Address - Phone:513-869-4917
Mailing Address - Fax:513-737-1592
Practice Address - Street 1:903 NW WASHINGTON BLVD STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-6367
Practice Address - Country:US
Practice Address - Phone:513-454-1111
Practice Address - Fax:513-737-1592
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.021048363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health