Provider Demographics
NPI:1760848642
Name:BULATHSINGHALAGE, OTTILIA (CNP)
Entity Type:Individual
Prefix:MRS
First Name:OTTILIA
Middle Name:
Last Name:BULATHSINGHALAGE
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 1:74 N BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3804
Mailing Address - Country:US
Mailing Address - Phone:513-424-7291
Mailing Address - Fax:
Practice Address - Street 1:3130 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2399
Practice Address - Country:US
Practice Address - Phone:513-584-4503
Practice Address - Fax:513-584-0462
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-08
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.18505363L00000X, 363LF0000X
OHAPRN.CNP.18505363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner