Healthcare Provider Details

I. General information

NPI: 1326098757
Provider Name (Legal Business Name): KRISTINE RENEE KAUFMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 10/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 N PERRY ST SUITE A
OTTAWA OH
45875-1173
US

IV. Provider business mailing address

1740 N PERRY ST SUITE A
OTTAWA OH
45875-1173
US

V. Phone/Fax

Practice location:
  • Phone: 419-523-0012
  • Fax: 419-523-3416
Mailing address:
  • Phone: 419-523-0012
  • Fax: 419-523-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.04561-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: