Healthcare Provider Details

I. General information

NPI: 1558255802
Provider Name (Legal Business Name): AMONETSONE TRACEY OKORODUDU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMONETSONE TRACEY KOLOH NURSE

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7047 PARLIAMENT PL
LIBERTY TWP OH
45011-8325
US

IV. Provider business mailing address

7047 PARLIAMENT PL
LIBERTY TWP OH
45011-8325
US

V. Phone/Fax

Practice location:
  • Phone: 513-293-3001
  • Fax:
Mailing address:
  • Phone: 513-293-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number469030
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: