Provider Demographics
NPI:1437595329
Name:HASENYAGER, KRISTINA K (MED, PC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:K
Last Name:HASENYAGER
Suffix:
Gender:F
Credentials:MED, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 E ENTERPRISE PKWY
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-2351
Mailing Address - Country:US
Mailing Address - Phone:330-840-2543
Mailing Address - Fax:330-487-1271
Practice Address - Street 1:2451 E ENTERPRISE PKWY
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2351
Practice Address - Country:US
Practice Address - Phone:330-840-2543
Practice Address - Fax:330-487-1271
Is Sole Proprietor?:No
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1000299101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health