Healthcare Provider Details

I. General information

NPI: 1528239779
Provider Name (Legal Business Name): CASSIE WARDLAW APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2008
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 6015
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 6015
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-0800
  • Fax: 513-803-0823
Mailing address:
  • Phone: 513-636-0800
  • Fax: 513-803-0823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.15601
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberCOA.15601-NP
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.0700457
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: