Healthcare Provider Details

I. General information

NPI: 1235774415
Provider Name (Legal Business Name): ERICA LEIGH SELLMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA LEIGH HOLDERBAUM

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 2010
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4200
  • Fax:
Mailing address:
  • Phone: 513-636-4415
  • Fax: 513-636-7805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.025849
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number025849
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: