Healthcare Provider Details

I. General information

NPI: 1780298703
Provider Name (Legal Business Name): AMY L MALMEDAHL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY L VIOLI

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7502 STATE RD STE 2210
CINCINNATI OH
45255-2595
US

IV. Provider business mailing address

7502 STATE RD STE 2210A
CINCINNATI OH
45255-2596
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-2070
  • Fax:
Mailing address:
  • Phone: 513-624-2077
  • Fax: 513-624-2077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0027594
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.0027594
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.363248
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: