Healthcare Provider Details

I. General information

NPI: 1952058000
Provider Name (Legal Business Name): LIA MARIE RATLIFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 FAR HILLS AVE STE 260
DAYTON OH
45429-2357
US

IV. Provider business mailing address

5250 FAR HILLS AVE STE 260
DAYTON OH
45429-2357
US

V. Phone/Fax

Practice location:
  • Phone: 937-293-4168
  • Fax:
Mailing address:
  • Phone: 937-293-4168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0026783
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN.CNP.0026783
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN.CNP.0026783
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: