Healthcare Provider Details

I. General information

NPI: 1205261989
Provider Name (Legal Business Name): HAYLEE MARIE HANNAH RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7690 DISCOVERY DR
WEST CHESTER OH
45069-6542
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-2263
  • Fax: 513-874-4579
Mailing address:
  • Phone: 513-585-5506
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD 6280
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: