Healthcare Provider Details

I. General information

NPI: 1164784351
Provider Name (Legal Business Name): JONATHAN P RUEDISUELI APRN, MSN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 HARRISON AVE
CINCINNATI OH
45248-1623
US

IV. Provider business mailing address

PO BOX 932958
CLEVELAND OH
44193-0028
US

V. Phone/Fax

Practice location:
  • Phone: 513-693-4035
  • Fax: 513-693-4036
Mailing address:
  • Phone: 615-425-4200
  • Fax: 615-425-4268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.327840
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1162168
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3013282
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.13528
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: