Healthcare Provider Details

I. General information

NPI: 1306093489
Provider Name (Legal Business Name): CHERRISSA FAGIN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2008
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1711
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-7747
  • Fax:
Mailing address:
  • Phone: 513-751-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN..203180
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: