Healthcare Provider Details

I. General information

NPI: 1619988110
Provider Name (Legal Business Name): MR. NICHOLAS JOHN KRUPLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7238 OLD CREEK LANE
CANAL WINCHESTER OH
43110
US

IV. Provider business mailing address

1231 MATTHIAS DR
COLUMBUS OH
43224
US

V. Phone/Fax

Practice location:
  • Phone: 614-833-5077
  • Fax:
Mailing address:
  • Phone: 614-267-2829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2278H0200X
TaxonomyHome Health Certified Respiratory Therapist
License Number2642993
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: