Healthcare Provider Details

I. General information

NPI: 1154817005
Provider Name (Legal Business Name): HALEY SCHLOTTMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 MACK RD
FAIRFIELD OH
45014-5379
US

IV. Provider business mailing address

3050 MACK RD
FAIRFIELD OH
45014-5379
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-6400
  • Fax:
Mailing address:
  • Phone: 513-636-8259
  • Fax: 513-636-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number021878
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.021878
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: