Individual
CHARITY L KRISTIANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
303 MAIN ST, GENOA, OH 43430-1610
(567) 225-4788
Mailing address
303 MAIN ST, GENOA, OH 43430-1610
(567) 225-4788
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
—
376J00000X
Homemaker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12345
—
OH
05
—
6202166
—
OH
Enumeration date
01/01/2021
Last updated
01/01/2021
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