Healthcare Provider Details

I. General information

NPI: 1669623872
Provider Name (Legal Business Name): ANNETTE MARIE PUGH R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 10/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

4030 ABBOTT RD
BROOKVILLE IN
47012-8172
US

V. Phone/Fax

Practice location:
  • Phone: 513-617-4845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number244456
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28175187A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: