Provider Demographics
NPI:1609433176
Name:HAAG, KRISTINA MARIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:MARIA
Last Name:HAAG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-3315
Mailing Address - Country:US
Mailing Address - Phone:513-868-7654
Mailing Address - Fax:
Practice Address - Street 1:1430 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-3315
Practice Address - Country:US
Practice Address - Phone:513-868-7654
Practice Address - Fax:513-737-0026
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.129971.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2921146Medicaid