Healthcare Provider Details

I. General information

NPI: 1689815524
Provider Name (Legal Business Name): JUDI L DESIMIO MS, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

2115 LEITER RD
MIAMISBURG OH
45342-3659
US

V. Phone/Fax

Practice location:
  • Phone: 937-395-8842
  • Fax: 937-395-8379
Mailing address:
  • Phone: 937-384-6800
  • Fax: 937-384-6939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN185319COA1
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA10443NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: