Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | COA03229NP | OH |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | NCCDRA104278460 | OH |
NPI | 1124294418 |
---|---|
Provider Name | Mrs. Gina Colleen Drake |
First Address | Columbus, OH 43205 |
Second Address | Columbus, OH 43228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 06/05/2008 |