Healthcare Provider Details

I. General information

NPI: 1427953454
Provider Name (Legal Business Name): ELIZABETH FEDERLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 LAKEWOOD DR
CINCINNATI OH
45248-3119
US

IV. Provider business mailing address

3637 LAKEWOOD DR
CINCINNATI OH
45248-3119
US

V. Phone/Fax

Practice location:
  • Phone: 513-910-2976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0043650
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: