Healthcare Provider Details

I. General information

NPI: 1043716400
Provider Name (Legal Business Name): ANN NIXDORF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 BELLEVUE AVE STE 4100
CINCINNATI OH
45219-3286
US

IV. Provider business mailing address

2830 VICTORY PKWY
CINCINNATI OH
45206-1785
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8990
  • Fax: 513-475-8577
Mailing address:
  • Phone: 513-585-5506
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.006970RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: