MEDICARE: RHYAN MAXBERRY FNP

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	163W00000X	Registered Nurse	RN 381405	OH
2	363LF0000X	Family Nurse Practitioner	026283	OH

General Provider Information

NPI Number	:	1619316668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHYAN MAXBERRY FNP

Provider Business Mailing Address
First Line	:	1473 LARANN LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5315
Country	:	US
Telephone Number	:	513-521-1960
Fax Number	:

Provider Business Practice Location Address
First Line	:	1473 LARANN LN
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-5315
Country	:	US
Telephone Number	:	513-521-1960
Fax Number	:

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

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	02/17/2020

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