Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN.CNP.023598 | OH |
NPI | 1144707852 |
---|---|
Provider Name | Elizabeth Stafford |
First Address | Columbus, OH 43205-2639 |
Second Address | Columbus, OH 43205-2639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2018 |
Last Update Date | 10/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0316421 | (05) | OH |