Healthcare Provider Details

I. General information

NPI: 1992730501
Provider Name (Legal Business Name): CRYSTAL WILMHOFF C.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 HIGHLAND AVE
CINCINNATI OH
45219
US

IV. Provider business mailing address

3130 HIGHLAND AVE
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-5239
  • Fax: 513-584-1131
Mailing address:
  • Phone: 513-584-5239
  • Fax: 513-584-1131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP05851
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: