Healthcare Provider Details

I. General information

NPI: 1164936019
Provider Name (Legal Business Name): BEE WELL PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 OBSERVATORY AVE
CINCINNATI OH
45208-2108
US

IV. Provider business mailing address

2730 OBSERVATORY AVE
CINCINNATI OH
45208-2108
US

V. Phone/Fax

Practice location:
  • Phone: 513-258-0896
  • Fax:
Mailing address:
  • Phone: 513-258-0896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number07905
License Number StateOH

VIII. Authorized Official

Name: TARA M KRIVORUCHKA
Title or Position: ADMINISTRATION
Credential:
Phone: 608-213-4410