Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | COA11694NP | OH |
NPI | 1033426044 |
---|---|
Provider Name | Jenna L Birdsell |
First Address | Springfield, OH 45505 |
Second Address | Springfield, OH 45505-1965 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2010 |
Last Update Date | 22/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3134147 | (05) | OH |