Healthcare Provider Details

I. General information

NPI: 1346632510
Provider Name (Legal Business Name): MELANIE NICOLE LUTTRELL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE 440
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2123 AUBURN AVE STE 440
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-648-8980
  • Fax: 513-648-8988
Mailing address:
  • Phone: 513-648-8980
  • Fax: 513-648-8988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number17119
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberCOA.17119-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: