Provider Demographics
NPI:1568803310
Name:KLEIN, DOUGLAS MATTHEW (CNP)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MATTHEW
Last Name:KLEIN
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 PARK DR
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-1314
Mailing Address - Country:US
Mailing Address - Phone:937-554-7762
Mailing Address - Fax:
Practice Address - Street 1:2115 LEITER RD STE 100
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3698
Practice Address - Country:US
Practice Address - Phone:937-866-0741
Practice Address - Fax:937-866-8861
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN389492163W00000X
OH022724363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse