Healthcare Provider Details

I. General information

NPI: 1528502440
Provider Name (Legal Business Name): TAMARA NEWSOCK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
CINCINNATI OH
45242-4402
US

IV. Provider business mailing address

9891 MONTGOMERY RD SUITE 340
CINCINNATI OH
45242-6424
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1111
  • Fax: 513-672-0212
Mailing address:
  • Phone: 513-865-5204
  • Fax: 513-672-0212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.019383
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: