MEDICARE: LORI OLLBERDING FNP

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	363LF0000X	Family Nurse Practitioner	COA.17981-NP	OH

General Provider Information

NPI Number	:	1942679139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI OLLBERDING FNP

Provider Business Mailing Address
First Line	:	131 SAUNDERSVILLE RD STE 160
Second Line	:
City	:	HENDERSONVILLE
State	:	TN
Zip	:	37075-8940
Country	:	US
Telephone Number	:	615-442-3517
Fax Number	:	855-540-4722

Provider Business Practice Location Address
First Line	:	4355 FERGUSON DR STE 270
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45245-5137
Country	:	US
Telephone Number	:	513-718-0115
Fax Number	:	513-718-0116

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

Provider Enumeration Date	:	09/18/2015
Last Update Date	:	12/07/2015

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