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General NPI Number Information
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NPI Number | 1164936019
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Entity Type | Organization
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Legal Business Name | BEE WELL PEDIATRICS, LLC
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Dates
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Enumeration Date | 11/29/2017
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Last Update Date | 11/29/2017
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Provider Practice Location Address
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Address Line | 2730 OBSERVATORY AVE
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City | CINCINNATI
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State | OH
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Zip | 45208-2108
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Country | US
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Telephone | 513-258-0896
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Fax |
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Provider Business Mailing Address
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Address Line | 2730 OBSERVATORY AVE
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City | CINCINNATI
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State | OH
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Zip | 45208-2108
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Country | US
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Telephone | 513-258-0896
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | TARA M KRIVORUCHKA
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Credential |
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Telephone | 608-213-4410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 07905
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License Number State | OH
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