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General NPI Number Information
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NPI Number | 1740152735
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Entity Type | Organization
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Legal Business Name | KETTERING HEALTH LEBANON HEALTH CENTER
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 1470 N BROADWAY ST STE 130
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City | LEBANON
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State | OH
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Zip | 45036-1762
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Country | US
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Telephone | 513-696-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 1470 N BROADWAY ST STE 130
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City | LEBANON
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State | OH
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Zip | 45036-1762
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Country | US
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Telephone | 513-696-1280
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Fax |
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Authorized Official
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Title or Position | APP
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Name | ANDREA SMITH
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Credential |
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Telephone | 513-939-8018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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