Healthcare Provider Details

I. General information

NPI: 1134585813
Provider Name (Legal Business Name): JENNIFER WILLMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 12/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

237 WILLIAM HOWARD TAFT RD CBO2-3, ATTN: CREDENTIALING
CINCINNATI OH
45219-2610
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-2062
  • Fax: 513-585-3099
Mailing address:
  • Phone: 513-263-8571
  • Fax: 513-366-4480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number313529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: