MEDICARE: ANN NIXDORF PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	50.006970RX	OH

General Provider Information

NPI Number	:	1043716400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN NIXDORF PA-C

Provider Business Mailing Address
First Line	:	2830 VICTORY PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1785
Country	:	US
Telephone Number	:	513-585-5506
Fax Number	:	513-585-5511

Provider Business Practice Location Address
First Line	:	3113 BELLEVUE AVE STE 4100
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-3286
Country	:	US
Telephone Number	:	513-475-8990
Fax Number	:	513-475-8577

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	06/08/2021

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Directions to “ ANN NIXDORF PA-C” Practice Location

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