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General NPI Number Information
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NPI Number | 1447713052
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Entity Type | Organization
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Legal Business Name | WESTERN AVENUE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 02/22/2023
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Provider Practice Location Address
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Address Line | 1101 WESTERN AVE
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City | HAMILTON
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State | OH
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Zip | 45013-2313
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Country | US
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Telephone | 513-887-2000
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Fax | 513-887-2300
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Provider Business Mailing Address
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Address Line | 1101 WESTERN AVE
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City | HAMILTON
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State | OH
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Zip | 45013-2313
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIMBERLY C HAUGABOOK
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Credential | APRN, FNP-C
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Telephone | 513-887-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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