MEDICARE: KOSTENDENA NICOLE KRONDILOU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	COA.14432-NP	OH

General Provider Information

NPI Number	:	1871935759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOSTENDENA NICOLE KRONDILOU

Provider Business Mailing Address
First Line	:	6942 TYLERSVILLE RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1511
Country	:	US
Telephone Number	:	513-868-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	6942 TYLERSVILLE RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-1511
Country	:	US
Telephone Number	:	513-868-0055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2013
Last Update Date	:	07/22/2013

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