=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033145248
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONNIE S SEESKIN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2006
-----------------------------------------------------
Last Update Date | 02/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9250 BLUE ASH ROAD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-792-7445
-----------------------------------------------------
Fax | 513-791-4042
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 237 WILLIAM HOWARD TAFT, PHYS DIV 2ND FL, CBO2-3, ATTN: CREDENTIALING
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45219-2906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-263-8571
-----------------------------------------------------
Fax | 513-366-4480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | COA.06923-MP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WX0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Registered Nurse
-----------------------------------------------------
License Number | RN-160618
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------