Healthcare Provider Details

I. General information

NPI: 1720645583
Provider Name (Legal Business Name): JENNIFER GEBHART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 S BREIEL BLVD
MIDDLETOWN OH
45044-5106
US

IV. Provider business mailing address

3218 PENNYROYAL RD
FRANKLIN OH
45005-1011
US

V. Phone/Fax

Practice location:
  • Phone: 385-202-6167
  • Fax:
Mailing address:
  • Phone: 937-623-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN438265
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: