Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | APRN.CNP.025806 | OH |
NPI | 1023648318 |
---|---|
Provider Name | Fardowsa O Khalif |
First Address | Columbus, OH 43230 |
Second Address | Columbus, OH 43215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2020 |
Last Update Date | 25/01/2020 |