Healthcare Provider Details

I. General information

NPI: 1821525247
Provider Name (Legal Business Name): TIM HUNTER FRIEMOTH BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2017
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6527 COLERAIN AVE
CINCINNATI OH
45239
US

IV. Provider business mailing address

6527 COLERAIN AVE
CINCINNATI OH
45239-5537
US

V. Phone/Fax

Practice location:
  • Phone: 513-834-7063
  • Fax: 513-873-1567
Mailing address:
  • Phone: 513-834-7063
  • Fax: 513-873-1567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN.376292
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: