Healthcare Provider Details

I. General information

NPI: 1265700488
Provider Name (Legal Business Name): KATRINA DANIELLE RICHARDSON RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA DANIELLE LEWIS RN, CNP

II. Dates (important events)

Enumeration Date: 12/02/2011
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE., ML 7015
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE., ML 7015
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4266
  • Fax: 513-636-3549
Mailing address:
  • Phone: 513-803-7987
  • Fax: 513-636-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.12848
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA.12848-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: