Healthcare Provider Details

I. General information

NPI: 1639515794
Provider Name (Legal Business Name): MS. NICOLE KRISTIN HANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 BROOKS MALOTT RD.
MT. ORAB OH
45154
US

IV. Provider business mailing address

292 BROOKS MALOTT RD.
MT. ORAB OH
45154
US

V. Phone/Fax

Practice location:
  • Phone: 937-444-0035
  • Fax: 937-444-0036
Mailing address:
  • Phone: 937-444-0035
  • Fax: 937-444-0036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number14472-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.14472
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: