Healthcare Provider Details

I. General information

NPI: 1194662981
Provider Name (Legal Business Name): JOSHUA WAYNE CANUPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1271 MILLVILLE AVE
HAMILTON OH
45013-5605
US

IV. Provider business mailing address

1271 MILLVILLE AVE
HAMILTON OH
45013-5605
US

V. Phone/Fax

Practice location:
  • Phone: 513-575-6164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: