Healthcare Provider Details

I. General information

NPI: 1023201944
Provider Name (Legal Business Name): MARY DENISE NESIUS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8094 BEECHMONT AVE
CINCINNATI OH
45255
US

IV. Provider business mailing address

8094 BEECHMONT AVE
CINCINNATI OH
45255
US

V. Phone/Fax

Practice location:
  • Phone: 513-232-7100
  • Fax: 513-232-6975
Mailing address:
  • Phone: 513-232-7100
  • Fax: 513-232-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28108574A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024184266
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRNCNP15860
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: