1861572984 NPI number — MRS. TARA CRABTREE-VOLLRATH APRN, NP

Table of content: MRS. TARA CRABTREE-VOLLRATH APRN, NP (NPI 1861572984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861572984 NPI number — MRS. TARA CRABTREE-VOLLRATH APRN, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRABTREE-VOLLRATH
Provider First Name:
TARA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CRABTREE
Provider Other First Name:
TARA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861572984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2060 READING RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45202-1454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-721-3200
Provider Business Mailing Address Fax Number:
513-639-3186

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7459 STATE RD
Provider Second Line Business Practice Location Address:
SUITE 325
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45230-2154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-233-2000
Provider Business Practice Location Address Fax Number:
513-624-2684
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  COA.09119-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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