Healthcare Provider Details

I. General information

NPI: 1235680117
Provider Name (Legal Business Name): BRIGID COLEEN MALONE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIGID COLEEN LAWLER

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE SUITE 139
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE SUITE 139
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-206-1170
  • Fax: 513-206-1172
Mailing address:
  • Phone: 513-206-1170
  • Fax: 513-206-1172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberCNP.020017
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.020017
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberCNP.020017
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: