Provider Demographics
NPI:1407017270
Name:PUTERBAUGH, NICOLE R (CNP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:R
Last Name:PUTERBAUGH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SMITH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-533-6000
Practice Address - Street 1:6825 WOOSTER PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45227-4328
Practice Address - Country:US
Practice Address - Phone:513-272-0250
Practice Address - Fax:513-272-1728
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP 10037363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2949671Medicaid
OH2949671Medicaid
OHPUNP29301Medicare PIN
OHPUNP29302Medicare PIN