Basic Information
| Provider Information | |||||||||
| NPI: | 1265965081 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEDONNE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8989 WINTON ROAD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452313817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137612776 | ||||||||
| FaxNumber: | 5136794866 | ||||||||
| Practice Location | |||||||||
| Address1: | 8989 WINTON ROAD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452313817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137612776 | ||||||||
| FaxNumber: | 5136794866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2017 | ||||||||
| LastUpdateDate: | 03/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 34.014461 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7100694190 | 05 | KY | MEDICAID | 0410890 | 05 | OH | MEDICAID |