Healthcare Provider Details

I. General information

NPI: 1629555321
Provider Name (Legal Business Name): LONNA L LARGER MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6331 GLENWAY AVE
CINCINNATI OH
45211-6301
US

IV. Provider business mailing address

6331 GLENWAY AVE
CINCINNATI OH
45211-6301
US

V. Phone/Fax

Practice location:
  • Phone: 513-346-1270
  • Fax: 513-346-1281
Mailing address:
  • Phone: 513-346-1270
  • Fax: 513-346-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number023330
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberLE-0024120
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4011274
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: