Basic Information
Provider Information
NPI: 1588290258
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BATES
FirstName: DAWNA
MiddleName: CHRISTINE
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 615 ELSINORE PL STE 200
Address2:  
City: CINCINNATI
State: OH
PostalCode: 452021459
CountryCode: US
TelephoneNumber: 5138347063
FaxNumber: 5138731567
Practice Location
Address1: 4660 ROBERTS RD
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432289671
CountryCode: US
TelephoneNumber: 5138347063
FaxNumber: 5138731567
Other Information
ProviderEnumerationDate: 03/13/2020
LastUpdateDate: 03/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN.461278OHY Nursing Service ProvidersRegistered Nurse 

No ID Information.


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