Provider Demographics
NPI:1063524239
Name:SCORDO, KRISTINE A (NP)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:A
Last Name:SCORDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-7615
Mailing Address - Country:US
Mailing Address - Phone:937-643-9939
Mailing Address - Fax:937-643-9949
Practice Address - Street 1:4000 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7615
Practice Address - Country:US
Practice Address - Phone:937-643-9939
Practice Address - Fax:937-643-9949
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN146504363LA2100X
OHCOA05877NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3138509Medicaid
S47738Medicare UPIN
OH3138509Medicaid