Provider Demographics
NPI:1851958169
Name:WALTON MOBILE NP OH LLC
Entity Type:Organization
Organization Name:WALTON MOBILE NP OH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRUN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:513-238-5982
Mailing Address - Street 1:1042 FUHRMAN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3936
Mailing Address - Country:US
Mailing Address - Phone:513-238-5982
Mailing Address - Fax:513-257-0481
Practice Address - Street 1:311 ELM STREET
Practice Address - Street 2:STE C1 #1156
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-4520
Practice Address - Country:US
Practice Address - Phone:513-238-5982
Practice Address - Fax:513-257-0418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health