Healthcare Provider Details

I. General information

NPI: 1669418687
Provider Name (Legal Business Name): JUDITH GROVE PFLAUMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11129 KENWOOD RD
BLUE ASH OH
45242-1817
US

IV. Provider business mailing address

11129 KENWOOD RD
BLUE ASH OH
45242-1817
US

V. Phone/Fax

Practice location:
  • Phone: 513-205-1822
  • Fax:
Mailing address:
  • Phone: 513-205-1822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3768P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number3768P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: