Healthcare Provider Details

I. General information

NPI: 1093398398
Provider Name (Legal Business Name): RACHEL ANN ENTRUP PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8099 CORNELL RD STE 100
CINCINNATI OH
45249-2231
US

IV. Provider business mailing address

10074 SONYA LN
WEST CHESTER OH
45241-3603
US

V. Phone/Fax

Practice location:
  • Phone: 513-354-3700
  • Fax: 513-793-1019
Mailing address:
  • Phone: 513-375-6702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.006891RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: