Healthcare Provider Details

I. General information

NPI: 1467190454
Provider Name (Legal Business Name): KAILA NIEHAUS APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE # MLC11006
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE # MLC11006
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4222
  • Fax: 513-636-3980
Mailing address:
  • Phone: 513-636-4222
  • Fax: 513-636-3980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0031321
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: