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NPI Code Detail

MEDICARE: ANJA VESANEN BROKAW NP-C

MEDICARE: ANJA VESANEN BROKAW NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WG0000XGeneral Practice Registered NurseRN.394211-COA1OH
2363LF0000XFamily Nurse PractitionerCOA.11799-NPOH

General Provider Information

NPI Number : 1144538885
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANJA VESANEN BROKAW NP-C
Provider Business Mailing Address
First Line : 1160 W BROAD ST
Second Line : LOWER LIGHTS CHRISTIAN HEALTH CENTER
City : COLUMBUS
State : OH
Zip : 43222-1317
Country : US
Telephone Number : 614-274-1455
Fax Number : 614-274-2040
Provider Business Practice Location Address
First Line : 1160 W BROAD ST
Second Line : LOWER LIGHTS CHRISTIAN HEALTH CENTER
City : COLUMBUS
State : OH
Zip : 43222-1317
Country : US
Telephone Number : 614-274-1455
Fax Number : 614-274-2040
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2010
Last Update Date : 08/08/2014

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1225286024 — MRS. ELIZABETH ANN HOOVER NPC
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1770854473 — LOWER LIGHTS CHRISTIAN HEALTH CENTER INC.
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