Healthcare Provider Details

I. General information

NPI: 1376857094
Provider Name (Legal Business Name): ALAN J ULLMAN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CONOVER DR STE B
FRANKLIN OH
45005-1900
US

IV. Provider business mailing address

333 CONOVER DR STE B
FRANKLIN OH
45005-1900
US

V. Phone/Fax

Practice location:
  • Phone: 513-318-1188
  • Fax: 513-318-1189
Mailing address:
  • Phone: 513-318-1188
  • Fax: 513-318-1189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 11601
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA-11601-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: