Healthcare Provider Details

I. General information

NPI: 1518235266
Provider Name (Legal Business Name): COLLEEN PRITCHARD BASS MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE SUITE 3147
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

2139 AUBURN AVE SUITE 3147
CINCINNATI OH
45219-2906
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-4157
  • Fax:
Mailing address:
  • Phone: 513-585-4157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.12979-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: