Provider Demographics
NPI:1457607681
Name:LINDSEY, ROSHAUNA (CNP)
Entity Type:Individual
Prefix:
First Name:ROSHAUNA
Middle Name:
Last Name:LINDSEY
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 1:42 EAST CRESCENTVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-0101
Mailing Address - Country:US
Mailing Address - Phone:513-671-7117
Mailing Address - Fax:513-671-7110
Practice Address - Street 1:42 EAST CRESCENTVILLE ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1302
Practice Address - Country:US
Practice Address - Phone:513-671-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.396648207QA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1457607681Medicaid