Healthcare Provider Details

I. General information

NPI: 1316501125
Provider Name (Legal Business Name): FERTILITY WELLNESS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7671 TYLERS PLACE BLVD
WEST CHESTER OH
45069-6331
US

IV. Provider business mailing address

7671 TYLERS PLACE BLVD
WEST CHESTER OH
45069-6331
US

V. Phone/Fax

Practice location:
  • Phone: 513-326-4300
  • Fax: 513-236-4306
Mailing address:
  • Phone: 513-326-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0006X
TaxonomyAmbulatory Fertility Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE RAE MCDONALD
Title or Position: PRACTICE ADMIN
Credential:
Phone: 513-680-7804