Healthcare Provider Details

I. General information

NPI: 1174837199
Provider Name (Legal Business Name): JILL SUSAN HASSMAN MLP NURSE PRACTITION
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

PO BOX 633448
CINCINNATI OH
45263-3448
US

V. Phone/Fax

Practice location:
  • Phone: 513-481-4777
  • Fax: 513-389-0473
Mailing address:
  • Phone: 513-569-6117
  • Fax: 513-853-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCOA.11741
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.308892
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: