Provider Demographics
NPI:1134540412
Name:ARNOLD, SALLY (DNP, AGPCNP-BC, CWOC)
Entity type:Individual
Prefix:DR
First Name:SALLY
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:DNP, AGPCNP-BC, CWOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 WILLIAM HOWARD TAFT RD
Mailing Address - Street 2:2ND FLOOR, CBO2-3
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2610
Mailing Address - Country:US
Mailing Address - Phone:513-585-4595
Mailing Address - Fax:513-585-4594
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:SU. 335
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-4595
Practice Address - Fax:513-585-4594
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRN.308338163W00000X
OHCOA.15502-NP363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0098265Medicaid
OHH277970Medicare PIN