Healthcare Provider Details

I. General information

NPI: 1891289674
Provider Name (Legal Business Name): JESSIE MARIE VADNAIS CPNP- PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE MARIE HOGEBACK CPNP- PC

II. Dates (important events)

Enumeration Date: 06/15/2018
Last Update Date: 03/15/2024
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

PO BOX 933421
CLEVELAND OH
44193-0039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-2706
  • Fax: 513-636-2988
Mailing address:
  • Phone: 937-641-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number20188105
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.023804
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.023804
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: