MEDICARE: MS. JUDITH DIANE COUCH 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	363LF0000X	Family Nurse Practitioner	NP07516	OH

General Provider Information

NPI Number	:	1639120280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH DIANE COUCH FNP

Provider Business Mailing Address
First Line	:	4004 WITHROW RD
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-9659
Country	:	US
Telephone Number	:	513-726-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	8837 CHAPELSQUARE LN
Second Line	:	SUITE A
City	:	CINCINNATI
State	:	OH
Zip	:	45249-4706
Country	:	US
Telephone Number	:	513-229-9355
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/30/2012

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