1487230108 NPI number — AMANDA RENEE KRODEL QMHS

Table of content: AMANDA RENEE KRODEL QMHS (NPI 1487230108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487230108 NPI number — AMANDA RENEE KRODEL QMHS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRODEL
Provider First Name:
AMANDA
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
QMHS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BRUCE
Provider Other First Name:
AMANDA
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
QMHS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487230108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 VICTORY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45206-1395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-751-7747
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4531 READING RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45229-1229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-751-7747
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2021

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: 171M00000X , 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)