Healthcare Provider Details

I. General information

NPI: 1417729583
Provider Name (Legal Business Name): DECEMBER N PENNEKAMP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5403 N BEND RD
CINCINNATI OH
45247-7620
US

IV. Provider business mailing address

5403 N BEND RD
CINCINNATI OH
45247-7620
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-9700
  • Fax: 513-852-8969
Mailing address:
  • Phone: 513-853-9700
  • Fax: 513-852-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0035176
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: