Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | NP07653 | OH |
NPI | 1003847658 |
---|---|
Provider Name | Joyce Fugate |
First Address | Cincinnati, OH 45243-2142 |
Second Address | Cincinnati, OH 45220-2402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |