Provider Demographics
NPI:1679359012
Name:OSTERHAGE, CRISTA (AGACNP)
Entity Type:Individual
Prefix:
First Name:CRISTA
Middle Name:
Last Name:OSTERHAGE
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3951 W FRANKLIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-1834
Mailing Address - Country:US
Mailing Address - Phone:937-818-1094
Mailing Address - Fax:
Practice Address - Street 1:3951 W FRANKLIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-1834
Practice Address - Country:US
Practice Address - Phone:937-818-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0034804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty