Healthcare Provider Details

I. General information

NPI: 1639874324
Provider Name (Legal Business Name): NICOLE VIOLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 COMMONS BLVD STE 120
BEAVERCREEK OH
45431-3827
US

IV. Provider business mailing address

2633 COMMONS BLVD STE 120
BEAVERCREEK OH
45431-3827
US

V. Phone/Fax

Practice location:
  • Phone: 937-986-1862
  • Fax: 937-986-1862
Mailing address:
  • Phone: 937-986-1862
  • Fax: 937-702-9041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.018912
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: