Healthcare Provider Details

I. General information

NPI: 1063860112
Provider Name (Legal Business Name): GWENDOLYN JAYE FELDHAUS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 09/15/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVENUE MLC 2008
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVENUE MLC 2008
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7966
  • Fax: 513-636-7967
Mailing address:
  • Phone: 513-636-7966
  • Fax: 513-636-7967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.022150
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.022150
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: