Healthcare Provider Details

I. General information

NPI: 1952812695
Provider Name (Legal Business Name): MITCHELL RUPARD AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2017
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4750 E GALBRAITH RD STE 207
CINCINNATI OH
45236-6706
US

IV. Provider business mailing address

4750 E GALBRAITH RD STE 207
CINCINNATI OH
45236-6706
US

V. Phone/Fax

Practice location:
  • Phone: 513-829-1700
  • Fax: 513-829-5333
Mailing address:
  • Phone: 513-829-1700
  • Fax: 513-829-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.021671
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: