Healthcare Provider Details

I. General information

NPI: 1346759263
Provider Name (Legal Business Name): MARY L DEUTCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 09/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 VINE ST
CINCINNATI OH
45220-2213
US

IV. Provider business mailing address

3200 VINE ST ATTN: MICHELLE MILLER, TELEICU, 9TH FLOOR
CINCINNATI OH
45220-2213
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-6436
  • Fax:
Mailing address:
  • Phone: 513-475-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021748
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: