Healthcare Provider Details

I. General information

NPI: 1073643458
Provider Name (Legal Business Name): MOLLY ELIZABETH BLATT CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY ADAMS CNP

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 CLIFTON AVE STE 315
CINCINNATI OH
45220-3047
US

IV. Provider business mailing address

PO BOX 636799
CINCINNATI OH
45263-6799
US

V. Phone/Fax

Practice location:
  • Phone: 513-624-0934
  • Fax: 513-624-0999
Mailing address:
  • Phone: 513-569-6422
  • Fax: 513-569-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP-09335
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: