Healthcare Provider Details

I. General information

NPI: 1083141337
Provider Name (Legal Business Name): ADAM ROBERT OSTERHAGE CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

967 BELLEFONTAINE AVE
LIMA OH
45804
US

IV. Provider business mailing address

967 BELLEFONTAINE AVE
LIMA OH
45804-2888
US

V. Phone/Fax

Practice location:
  • Phone: 419-996-5895
  • Fax: 419-996-5896
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRNCNP021865
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021865
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: