Provider Demographics
NPI:1528239779
Name:WARDLAW, CASSIE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:CASSIE
Middle Name:
Last Name:WARDLAW
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 6015
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-0800
Mailing Address - Fax:513-803-0823
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 6015
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-0800
Practice Address - Fax:513-803-0823
Is Sole Proprietor?:No
Enumeration Date:2008-03-16
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.07004571041C0700X
OHCOA.15601-NP363LP0808X
OHAPRN.CNP.15601363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health