Provider Demographics
NPI:1396283388
Name:HAKER, KRISTINA M (PA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:HAKER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:30 E APPLE ST
Mailing Address - Street 2:SUITE 5254A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-2939
Mailing Address - Country:US
Mailing Address - Phone:937-208-4200
Mailing Address - Fax:937-208-4205
Practice Address - Street 1:30 E APPLE ST
Practice Address - Street 2:SUITE 5254A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-4200
Practice Address - Fax:937-208-4205
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH50.004982RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant