Healthcare Provider Details

I. General information

NPI: 1316273907
Provider Name (Legal Business Name): MARY C BRADY, CNP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 DEANVIEW DR
CINCINNATI OH
45224-1415
US

IV. Provider business mailing address

430 DEANVIEW DR
CINCINNATI OH
45224-1415
US

V. Phone/Fax

Practice location:
  • Phone: 513-310-3007
  • Fax:
Mailing address:
  • Phone: 513-310-3007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number08812
License Number StateOH

VIII. Authorized Official

Name: MARY CATHERINE BRADY
Title or Position: OWNER
Credential: CNP
Phone: 513-310-3007