Healthcare Provider Details

I. General information

NPI: 1073440012
Provider Name (Legal Business Name): JULIET H FANNING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VELIS HALLORAN FANNING

II. Dates (important events)

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

III. Provider practice location address

8044 MONTGOMERY RD STE 120
CINCINNATI OH
45236-2919
US

IV. Provider business mailing address

102 W CLIFTON AVE APT 2
CINCINNATI OH
45202-4909
US

V. Phone/Fax

Practice location:
  • Phone: 513-706-7111
  • Fax:
Mailing address:
  • Phone: 513-706-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: