Basic Information
| Provider Information | |||||||||
| NPI: | 1851447643 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GANSHIRT | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | CHRISTINE | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4685 FOREST AVE | ||||||||
| Address2: | STE C | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452123359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592125125 | ||||||||
| FaxNumber: | 8592125099 | ||||||||
| Practice Location | |||||||||
| Address1: | 7370 TURFWAY RD | ||||||||
| Address2: | STE 390 | ||||||||
| City: | FLORENCE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410424895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592125125 | ||||||||
| FaxNumber: | 8592125099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 10/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 3004936 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 7100046190 | 05 | KY | MEDICAID | 0060644 | 05 | OH | MEDICAID | P00985229 | 01 | KY | RAILROAD MEDICARE | OTHER |