Healthcare Provider Details

I. General information

NPI: 1619625886
Provider Name (Legal Business Name): ASHLEY ELIZABETH PUOPOLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2018
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

2721 MORGAN WAY UNIT 410
CINCINNATI OH
45212-2575
US

V. Phone/Fax

Practice location:
  • Phone: 516-636-4355
  • Fax: 513-636-8133
Mailing address:
  • Phone: 631-949-9490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0030934
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030934
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: