Provider Demographics
NPI:1679227300
Name:CIRILLO, ELIZABETH R (CNM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:R
Last Name:CIRILLO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 FAIRVIEW PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1118
Mailing Address - Country:US
Mailing Address - Phone:513-482-1865
Mailing Address - Fax:
Practice Address - Street 1:359 FOREST AVE STE 202
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4559
Practice Address - Country:US
Practice Address - Phone:937-228-4492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.0019482367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife