Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | APRN.CNP.0027065 | OH |
NPI | 1215557871 |
---|---|
Provider Name | Kelly Elizabeth Ventresco |
First Address | Columbus, OH 43215-1898 |
Second Address | Columbus, OH 43215-1898 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2020 |
Last Update Date | 16/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0410332 | (05) | OH |