Healthcare Provider Details

I. General information

NPI: 1134789910
Provider Name (Legal Business Name): TATYANA KLOCHAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 05/15/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 MONTGOMERY RD
CINCINNATI OH
45212-1644
US

IV. Provider business mailing address

11113 WOOD AVE
BLUE ASH OH
45242-1967
US

V. Phone/Fax

Practice location:
  • Phone: 513-993-5241
  • Fax: 513-576-2768
Mailing address:
  • Phone: 513-300-7504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0035345
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number396963
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: