Healthcare Provider Details

I. General information

NPI: 1841968674
Provider Name (Legal Business Name): ROHAN SUZANNE OTT APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506 MONTGOMERY RD
MONTGOMERY OH
45242-4487
US

IV. Provider business mailing address

10506 MONTGOMERY RD STE 304
MONTGOMERY OH
45242-4400
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-9000
  • Fax:
Mailing address:
  • Phone: 513-853-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.025746
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberCNP.025746
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: