Healthcare Provider Details

I. General information

NPI: 1619929437
Provider Name (Legal Business Name): JEAN A HOLTHAUS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 EXECUTIVE PARK DR STE 406
CINCINNATI OH
45241-4017
US

IV. Provider business mailing address

PO BOX 632778
CINCINNATI OH
45263-2778
US

V. Phone/Fax

Practice location:
  • Phone: 513-569-6747
  • Fax: 513-569-6988
Mailing address:
  • Phone: 513-891-7574
  • Fax: 513-793-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP-06838
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: