MEDICARE: MOLLY ELIZABETH SHEELEY NP-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	363LF0000X	Family Nurse Practitioner	022368	OH
2	363LF0000X	Family Nurse Practitioner	3012185	KY

General Provider Information

NPI Number	:	1376045187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY ELIZABETH SHEELEY NP-C

Provider Business Mailing Address
First Line	:	2000 JOSEPH E SANKER BLVD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-1979
Country	:	US
Telephone Number	:	513-841-7404
Fax Number	:	513-841-7402

Provider Business Practice Location Address
First Line	:	350 THOMAS MORE PKWY STE 200
Second Line	:
City	:	CRESTVIEW HILLS
State	:	KY
Zip	:	41017-5460
Country	:	US
Telephone Number	:	513-841-7404
Fax Number	:	513-841-7402

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

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	05/01/2019

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