Healthcare Provider Details

I. General information

NPI: 1528726726
Provider Name (Legal Business Name): MATTHEW REDMOND CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 12/04/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 AMBROSE AVE
CINCINNATI OH
45224-2509
US

IV. Provider business mailing address

1528 AMBROSE AVE
CINCINNATI OH
45224-2509
US

V. Phone/Fax

Practice location:
  • Phone: 513-478-9463
  • Fax:
Mailing address:
  • Phone: 513-478-9463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0027891
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0027891
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: