Healthcare Provider Details

I. General information

NPI: 1174325799
Provider Name (Legal Business Name): TAYLOR HAUSFELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7770 COOPER RD STE 5
MONTGOMERY OH
45242-7700
US

IV. Provider business mailing address

309 MONTERAY AVE
OAKWOOD OH
45419-2652
US

V. Phone/Fax

Practice location:
  • Phone: 513-400-4613
  • Fax:
Mailing address:
  • Phone: 937-882-2784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0038944
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: