MEDICARE: ADULT & GERIATRIC NP VISITS LLC

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	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1083455083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT & GERIATRIC NP VISITS LLC

Provider Business Mailing Address
First Line	:	3304 WOODSIDE DR
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5023
Country	:	US
Telephone Number	:	513-535-1969
Fax Number	:

Provider Business Practice Location Address
First Line	:	3304 WOODSIDE DR
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-5023
Country	:	US
Telephone Number	:	513-535-1969
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	PATRICIA SEARS
Credential	:	NP
Telephone Number	:	513-535-1969

Provider Enumeration Date	:	06/04/2024
Last Update Date	:	07/22/2024

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