Provider Demographics
NPI:1134789910
Name:KLOCHAN, TATYANA (RN)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:KLOCHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11113 WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-1967
Mailing Address - Country:US
Mailing Address - Phone:513-300-7504
Mailing Address - Fax:
Practice Address - Street 1:5241 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-1644
Practice Address - Country:US
Practice Address - Phone:513-993-5241
Practice Address - Fax:513-576-2768
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-14
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH396963163W00000X
OH0035345363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse