Healthcare Provider Details

I. General information

NPI: 1316945397
Provider Name (Legal Business Name): SUSAN DOLPH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
CINCINNATI OH
45242-4402
US

IV. Provider business mailing address

200 NORTHLAND BLVD FL 1
CINCINNATI OH
45246-3604
US

V. Phone/Fax

Practice location:
  • Phone: 513-672-3309
  • Fax: 513-672-3323
Mailing address:
  • Phone: 513-672-4128
  • Fax: 513-672-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number102487
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: