=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336705789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANNA ALBERS DPM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2019
-----------------------------------------------------
Last Update Date | 06/25/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4777 E GALBRAITH RD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45236-2814
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-686-5716
-----------------------------------------------------
Fax | 513-686-3154
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3516 BURCH AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45208-1316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-639-6559
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 59.000778
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------