Healthcare Provider Details

I. General information

NPI: 1356342562
Provider Name (Legal Business Name): SUSAN J HOLDEN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7495 STATE RD STE 300
CINCINNATI OH
45255-6402
US

IV. Provider business mailing address

2060 READING RD SUITE 150
CINCINNATI OH
45202-1454
US

V. Phone/Fax

Practice location:
  • Phone: 513-231-3447
  • Fax: 513-231-3761
Mailing address:
  • Phone: 513-721-3200
  • Fax: 513-639-3186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN156009
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberNM1181
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: