Provider Demographics
NPI:1174837199
Name:HASSMAN, JILL SUSAN (MLP NURSE PRACTITION)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:SUSAN
Last Name:HASSMAN
Suffix:
Gender:F
Credentials:MLP NURSE PRACTITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 633448
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-3448
Mailing Address - Country:US
Mailing Address - Phone:513-569-6117
Mailing Address - Fax:513-853-4740
Practice Address - Street 1:379 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-481-4777
Practice Address - Fax:513-389-0473
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.308892163W00000X
OHCOA.11741363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0133033Medicaid
OHNP37041Medicare PIN