Healthcare Provider Details

I. General information

NPI: 1952784050
Provider Name (Legal Business Name): JILLIAN MAGNER RN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JILLIAN GEHLFUSS RN, FNP

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BURNET AVE CINCINNATI HEALTH DEPARTMENT
CINCINNATI OH
45229
US

IV. Provider business mailing address

3101 BURNET AVE CINCINNATI HEALTH DEPARTMENT
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-357-7289
  • Fax:
Mailing address:
  • Phone: 513-357-7289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05170162
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN.386859
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: