Healthcare Provider Details

I. General information

NPI: 1811232077
Provider Name (Legal Business Name): TERESA ANNE DUFFY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TERESA ANNE NASSER RN

II. Dates (important events)

Enumeration Date: 11/29/2012
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE CT SURGERY ML 2004
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE CT SURGERY ML 2004
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4770
  • Fax: 513-636-3847
Mailing address:
  • Phone: 513-636-4770
  • Fax: 513-636-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberCOA.14107-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: