MEDICARE: MATTHEW REDMOND CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	0027891	OH
2	363L00000X	Nurse Practitioner	0027891	OH

General Provider Information

NPI Number	:	1528726726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW REDMOND CNP

Provider Business Mailing Address
First Line	:	1528 AMBROSE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2509
Country	:	US
Telephone Number	:	513-478-9463
Fax Number	:

Provider Business Practice Location Address
First Line	:	1528 AMBROSE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-2509
Country	:	US
Telephone Number	:	513-478-9463
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2021
Last Update Date	:	12/04/2021

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