Healthcare Provider Details

I. General information

NPI: 1528360203
Provider Name (Legal Business Name): BRITTANY N NORDIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MACK RD STE 100
FAIRFIELD OH
45014-5335
US

IV. Provider business mailing address

3000 MACK RD STE 100
FAIRFIELD OH
45014-5335
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-4222
  • Fax: 513-874-3023
Mailing address:
  • Phone: 513-751-4222
  • Fax: 513-874-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58.003733
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number34010358
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS017908
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: