Healthcare Provider Details

I. General information

NPI: 1770027591
Provider Name (Legal Business Name): REBECCA LELII CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2008
CINCINNATI OH
45229
US

IV. Provider business mailing address

3333 BURNET AVE ML 5021
CINCINNATI OH
45229
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-7966
  • Fax: 513-636-7967
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN-CNP.17678
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.17678
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: