Provider Demographics
NPI:1992976393
Name:ROST-MANGAN, KRISTINA A (MS, RN, CNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:A
Last Name:ROST-MANGAN
Suffix:
Gender:F
Credentials:MS, RN, CNP
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8999
Mailing Address - Fax:937-298-9673
Practice Address - Street 1:2912 SPRINGBORO W
Practice Address - Street 2:SUITE 200
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1674
Practice Address - Country:US
Practice Address - Phone:937-297-8999
Practice Address - Fax:937-298-9673
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 09945-NP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2825527Medicaid
OHH196460Medicare PIN