Healthcare Provider Details

I. General information

NPI: 1932666138
Provider Name (Legal Business Name): SARAH ELLEN DIERSING APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2019
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE., ML 2017
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE., ML 2017
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4454
  • Fax: 513-636-3928
Mailing address:
  • Phone: 513-636-4454
  • Fax: 513-636-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.024500
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: