Healthcare Provider Details

I. General information

NPI: 1447737226
Provider Name (Legal Business Name): IESHA CAPEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 HAZELCREST LN
CINCINNATI OH
45231-1133
US

IV. Provider business mailing address

2577 HAZELCREST LN
CINCINNATI OH
45231-1133
US

V. Phone/Fax

Practice location:
  • Phone: 513-591-9803
  • Fax:
Mailing address:
  • Phone: 513-591-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number423140
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: