Basic Information
| Provider Information | |||||||||
| NPI: | 1235446527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLOUGHBY | ||||||||
| FirstName: | CHARITY | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2139 AUBURN AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452192906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135573333 | ||||||||
| FaxNumber: | 5135573506 | ||||||||
| Practice Location | |||||||||
| Address1: | 3131 QUEEN CITY AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452382316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135573333 | ||||||||
| FaxNumber: | 5135573506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2010 | ||||||||
| LastUpdateDate: | 07/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 11644 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 363L00000X | 11644 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.