Provider Demographics
NPI:1619929437
Name:HOLTHAUS, JEAN A (CNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:HOLTHAUS
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:PO BOX 632778
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2778
Mailing Address - Country:US
Mailing Address - Phone:513-891-7574
Mailing Address - Fax:513-793-1032
Practice Address - Street 1:4015 EXECUTIVE PARK DR
Practice Address - Street 2:STE 406
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4017
Practice Address - Country:US
Practice Address - Phone:513-569-6747
Practice Address - Fax:513-569-6988
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-06838363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2592494Medicaid
OHP00287513OtherRAILROAD MEDICARE
OHNP10792Medicare PIN
OHP00287513OtherRAILROAD MEDICARE