Healthcare Provider Details

I. General information

NPI: 1659672749
Provider Name (Legal Business Name): ANIE DJIADEU FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CAMELOT CIR APT E
FAIRFIELD OH
45014-4012
US

IV. Provider business mailing address

2681 APEX CT
FAIRFIELD TOWNSHIP OH
45011-5030
US

V. Phone/Fax

Practice location:
  • Phone: 513-330-6962
  • Fax:
Mailing address:
  • Phone: 513-765-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021260
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number134617
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: