MEDICARE: JULIAN IKENNA EGBO

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	363LF0000X	Family Nurse Practitioner	0041430	OH

General Provider Information

NPI Number	:	1093667305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIAN IKENNA EGBO

Provider Business Mailing Address
First Line	:	15 RIDGEWOOD PL
Second Line	:
City	:	FORT THOMAS
State	:	KY
Zip	:	41075-1667
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 W CORRY ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-1901
Country	:	US
Telephone Number	:	513-853-9700
Fax Number	:

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

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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