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General NPI Number Information
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NPI Number | 1053800847
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Entity Type | Organization
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Legal Business Name | EXTENDED NP CARE LLC
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 225 CLEVELAND AVE
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City | MILFORD
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State | OH
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Zip | 45150-1099
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Country | US
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Telephone | 513-248-1270
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Fax |
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Provider Business Mailing Address
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Address Line | 7854 SPLIT RAIL CT
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City | MASON
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State | OH
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Zip | 45040-7982
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Country | US
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Telephone | 513-204-2854
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Fax | 937-544-4009
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN ELIZABETH HEENAN
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Credential | NP
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Telephone | 937-544-4020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | OH
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