Healthcare Provider Details

I. General information

NPI: 1366014276
Provider Name (Legal Business Name): NICHOLAS WARNDORFF RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: NICK WARNDORFF RN

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 GOODMAN ST DEPT OF
CINCINNATI OH
45219-2364
US

IV. Provider business mailing address

2970 WERK RD
CINCINNATI OH
45211-7019
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8000
  • Fax:
Mailing address:
  • Phone: 513-315-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN.420919
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN.CRNA.0020972
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: