Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | APRN.CNP.023259 | OH |
NPI | 1053898270 |
---|---|
Provider Name | Antonette Hurst |
First Address | Pickerington, OH 43147-1462 |
Second Address | Columbus, OH 43205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2018 |
Last Update Date | 17/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0304578 | (05) | OH |