Healthcare Provider Details

I. General information

NPI: 1861322752
Provider Name (Legal Business Name): JADE N UNDERWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 VINE ST
CINCINNATI OH
45219-2068
US

IV. Provider business mailing address

7711 BLACK WALNUT DR
AVON IN
46123-9517
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-5500
  • Fax:
Mailing address:
  • Phone: 812-281-1611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28269459C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: