1265700363 NPI number — DR. KRISTEN HANZAK WALTER PH.D.

Table of content: DR. KRISTEN HANZAK WALTER PH.D. (NPI 1265700363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265700363 NPI number — DR. KRISTEN HANZAK WALTER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTER
Provider First Name:
KRISTEN
Provider Middle Name:
HANZAK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265700363
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 S FORT THOMAS AVE
Provider Second Line Business Mailing Address:
CINCINNATI VAMC - FT. THOMAS DIVISION; PTSD
Provider Business Mailing Address City Name:
FORT THOMAS
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41075-2305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-861-3100
Provider Business Mailing Address Fax Number:
589-572-6748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 S FORT THOMAS AVE
Provider Second Line Business Practice Location Address:
CINCINNATI VAMC - FT. THOMAS DIVISION; PTSD
Provider Business Practice Location Address City Name:
FORT THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-861-3100
Provider Business Practice Location Address Fax Number:
589-572-6748
Provider Enumeration Date:
12/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  6862 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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