Healthcare Provider Details

I. General information

NPI: 1376867481
Provider Name (Legal Business Name): MRS. JESIAH LOU BERTSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESIAH LOU JOLLY C.N.M.

II. Dates (important events)

Enumeration Date: 03/18/2010
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

PO BOX 636256
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-721-2221
  • Fax: 513-345-6665
Mailing address:
  • Phone: 513-245-3600
  • Fax: 513-245-3672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCOA.11377-NM
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: