MEDICARE: MRS. THERESA ANN HASELMAYER RN

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	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1114636909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. THERESA ANN HASELMAYER RN

Provider Business Mailing Address
First Line	:	2368 NORWOOD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2752
Country	:	US
Telephone Number	:	513-254-6473
Fax Number	:

Provider Business Practice Location Address
First Line	:	2368 NORWOOD AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2752
Country	:	US
Telephone Number	:	513-254-6473
Fax Number	:

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

Provider Enumeration Date	:	11/21/2022
Last Update Date	:	11/21/2022

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