Healthcare Provider Details

I. General information

NPI: 1275933574
Provider Name (Legal Business Name): LEE SCHWIETERMAN CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3533 SOUTHERN BLVD STE 5650
KETTERING OH
45429-1263
US

IV. Provider business mailing address

3533 SOUTHERN BLVD STE 5650
KETTERING OH
45429-1263
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-3611
  • Fax: 937-294-9010
Mailing address:
  • Phone: 937-294-3611
  • Fax: 937-294-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOA.15990-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.15990
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: