Healthcare Provider Details

I. General information

NPI: 1477184166
Provider Name (Legal Business Name): NICOLE CARROLL JANEK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

3142 COURT VIEW DR APT 2
BEAVERCREEK OH
45431-8841
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-4157
  • Fax: 513-585-4244
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: