Healthcare Provider Details

I. General information

NPI: 1518384353
Provider Name (Legal Business Name): CRISTA KOLLMANN AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2014
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 BEECHMONT AVE
CINCINNATI OH
45255-4216
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD 2ND FLOOR, CBO2-3, ATTN: CREDENTIALING
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-0011
  • Fax: 513-232-8434
Mailing address:
  • Phone: 513-263-8551
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberCOA.15706-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: