Individual
JENIFER GEISS VANDEHATERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3200 VINE ST, CINCINNATI, OH 45220-2213
(513) 861-3100
(513) 475-6470
Mailing address
3180 KLEEMAN RD, CINCINNATI, OH 45211-1932
(513) 260-5815
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
OH002813
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000610048
ANTHEM
OH
01
—
0225920002
NSC
OH
01
—
VAPA32961
MEDICARE
OH
Enumeration date
02/27/2008
Last updated
07/08/2009
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