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Organization
WESTERN AVENUE FAMILY PRACTICE LLC
Active
Organization
WESTERN AVENUE FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY C HAUGABOOK APRN, FNP-C (OWNER)
(513) 887-2000
Entity
Organization
Contact information
Practice address
1101 WESTERN AVE, HAMILTON, OH 45013-2313
(513) 887-2000
(513) 887-2300
Mailing address
1101 WESTERN AVE, HAMILTON, OH 45013-2313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0373306
—
OH
01
—
DZ5886
RRMEDICARE PTAN
OH
01
—
H277047
MEDICARE PTAN
OH
Enumeration date
04/10/2019
Last updated
02/22/2023
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