Healthcare Provider Details

I. General information

NPI: 1568643765
Provider Name (Legal Business Name): AMBER LEIGH BOOTS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9775 COLERAIN AVE
CINCINNATI OH
45251-1442
US

IV. Provider business mailing address

9775 COLERAIN AVE
CINCINNATI OH
45251-1442
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-9700
  • Fax: 513-853-8971
Mailing address:
  • Phone: 513-853-9700
  • Fax: 513-853-8971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP10053
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.10053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: