Healthcare Provider Details

I. General information

NPI: 1083463913
Provider Name (Legal Business Name): BALEIGH BOGNAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NIMITZVIEW DR STE 400
CINCINNATI OH
45230-4332
US

IV. Provider business mailing address

1080 NIMITZVIEW DR STE 400
CINCINNATI OH
45230-4332
US

V. Phone/Fax

Practice location:
  • Phone: 419-309-3991
  • Fax:
Mailing address:
  • Phone: 419-309-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: