Healthcare Provider Details

I. General information

NPI: 1962367078
Provider Name (Legal Business Name): ELIZABETH FELDHAUS BOETTCHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 DICK RD
HARRISON OH
45030-8728
US

IV. Provider business mailing address

9900 DICK RD
HARRISON OH
45030-8728
US

V. Phone/Fax

Practice location:
  • Phone: 513-619-0446
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN308166
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: