Healthcare Provider Details

I. General information

NPI: 1871863076
Provider Name (Legal Business Name): ANGELA BRONZIE NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2022
Certification Date: 01/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1613 BLOOMINGDALE AVE
CINCINNATI OH
45230-1709
US

IV. Provider business mailing address

1613 BLOOMINGDALE AVE
CINCINNATI OH
45230-1709
US

V. Phone/Fax

Practice location:
  • Phone: 513-238-8899
  • Fax:
Mailing address:
  • Phone: 513-238-8899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-001971
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-1146730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: