Healthcare Provider Details

I. General information

NPI: 1811561988
Provider Name (Legal Business Name): TESSA THULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
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:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberPA2719
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008281RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: