Healthcare Provider Details

I. General information

NPI: 1497245062
Provider Name (Legal Business Name): MR. CHRISTOPHER PATRICK RALEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE 201
CINCINNATI OH
45219
US

IV. Provider business mailing address

3607 LEGEND OAKS DR
AMELIA OH
45102-1267
US

V. Phone/Fax

Practice location:
  • Phone: 513-206-1170
  • Fax: 513-206-1172
Mailing address:
  • Phone: 513-502-7219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.308327
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN308327
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.023425
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: