Healthcare Provider Details

I. General information

NPI: 1235548322
Provider Name (Legal Business Name): MRS. ELIZABETH MICA GILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MIDDLETOWN OH
45005-2584
US

IV. Provider business mailing address

1 MEDICAL CENTER DR
MIDDLETOWN OH
45005-2584
US

V. Phone/Fax

Practice location:
  • Phone: 513-705-4031
  • Fax: 513-420-5005
Mailing address:
  • Phone: 513-705-4031
  • Fax: 513-420-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN.302957-COA1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: