Healthcare Provider Details

I. General information

NPI: 1114835402
Provider Name (Legal Business Name): NICOLE DONNELLON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 VICTORY PKWY UNIT 1
CINCINNATI OH
45207-5311
US

IV. Provider business mailing address

2505 ARDMORE AVE
CINCINNATI OH
45237-4413
US

V. Phone/Fax

Practice location:
  • Phone: 513-745-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: