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General NPI Number Information
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NPI Number | 1669005286
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Entity Type | Individual
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Provider Name | ZACHARY NORDYKE
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Gender | Male
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 5880 WINTON RIDGE LN
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City | CINCINNATI
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State | OH
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Zip | 45232-1121
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Country | US
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Telephone | 513-426-6363
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 GRANDIN RD APT 405
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City | CINCINNATI
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State | OH
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Zip | 45208-3343
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Country | US
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Telephone | 513-623-8422
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Fax | 888-460-4717
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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