Healthcare Provider Details

I. General information

NPI: 1124748843
Provider Name (Legal Business Name): VINCENT COLLIN NEALEY DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLINIC #7790 947 CINCINNATI BATAVIA PIKE
CINCINNATI OH
45245-1303
US

IV. Provider business mailing address

2121 ALPINE PL APT 303
CINCINNATI OH
45206-2691
US

V. Phone/Fax

Practice location:
  • Phone: 513-943-2801
  • Fax:
Mailing address:
  • Phone: 513-702-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0031667
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.395460
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: