Healthcare Provider Details

I. General information

NPI: 1760848642
Provider Name (Legal Business Name): OTTILIA BULATHSINGHALAGE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 HIGHLAND AVE
CINCINNATI OH
45219-2399
US

IV. Provider business mailing address

74 N BREIEL BLVD
MIDDLETOWN OH
45042-3804
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-4503
  • Fax: 513-584-0462
Mailing address:
  • Phone: 513-424-7291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA.18505
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.18505
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.18505
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: