Healthcare Provider Details

I. General information

NPI: 1134059603
Provider Name (Legal Business Name): JUDITH L RE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11161 KENWOOD RD
BLUE ASH OH
45242-1817
US

IV. Provider business mailing address

11161 KENWOOD RD
BLUE ASH OH
45242-1817
US

V. Phone/Fax

Practice location:
  • Phone: 513-300-5071
  • Fax:
Mailing address:
  • Phone: 513-300-5071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN.405153
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: