Basic Information
| Provider Information | |||||||||
| NPI: | 1376099556 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NATIONWIDE CHILDREN'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5076 MEDALLION DR W | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430829592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142161107 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 CHILDRENS DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432052664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147222000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2016 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| AuthorizedOfficialLastName: | FOSSELMAN | ||||||||
| AuthorizedOfficialFirstName: | KRISTA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | NEONATAL NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 6142161107 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MS, NNP-BC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | FOS1-0440-0733 | OH | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.