MEDICARE: AMY DADOSKY APRN

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	363LG0600X	Gerontology Nurse Practitioner	021548	OH

General Provider Information

NPI Number	:	1285152850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY DADOSKY APRN

Provider Business Mailing Address
First Line	:	7545 BEECHMONT AVE STE A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-4238
Country	:	US
Telephone Number	:	513-624-9100
Fax Number	:	513-624-7840

Provider Business Practice Location Address
First Line	:	7545 BEECHMONT AVE STE A
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-4238
Country	:	US
Telephone Number	:	513-624-9100
Fax Number	:

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

Provider Enumeration Date	:	09/05/2017
Last Update Date	:	10/05/2017

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