Healthcare Provider Details

I. General information

NPI: 1477110518
Provider Name (Legal Business Name): NICOLE CORDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 04/16/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 W 4TH ST
CINCINNATI OH
45202-2713
US

IV. Provider business mailing address

331 W 4TH ST
CINCINNATI OH
45202-2713
US

V. Phone/Fax

Practice location:
  • Phone: 614-500-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0028070
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number434776
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: