Healthcare Provider Details

I. General information

NPI: 1255737433
Provider Name (Legal Business Name): MARY ANNE ADAMS RN, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ANNE CASSIANI

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6139 GLENWAY AVE
CINCINNATI OH
45211-6312
US

IV. Provider business mailing address

6139 GLENWAY AVENUE
CINCINNATI OH
45211-6312
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-3399
  • Fax: 513-389-0957
Mailing address:
  • Phone: 513-346-3399
  • Fax: 513-389-0957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041.287085
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.012185
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: