=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184742934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANN SUTTMANN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2454 KIPLING AVENUE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-541-0700
-----------------------------------------------------
Fax | 513-541-2530
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4380 MALSBARY RD SUITE 200
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-5644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-366-4488
-----------------------------------------------------
Fax | 513-366-4480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | NP09318
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------