Basic Information
| Provider Information | |||||||||
| NPI: | 1417286626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOTTMANN | ||||||||
| FirstName: | RHONDA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5053 WOOSTER RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452262326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137512273 | ||||||||
| FaxNumber: | 5137512138 | ||||||||
| Practice Location | |||||||||
| Address1: | 71 E HOLLISTER ST | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452191703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137512273 | ||||||||
| FaxNumber: | 5137511840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2009 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 11255NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 200975140 | 05 | IN | MEDICAID | 7100112250 | 05 | KY | MEDICAID | 3043174 | 05 | OH | MEDICAID |