Healthcare Provider Details

I. General information

NPI: 1295869105
Provider Name (Legal Business Name): NAN E CRINER RN, BSN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 KNIGHTSBRIDGE BLVD SUITE A
COLUMBUS OH
43214-2352
US

IV. Provider business mailing address

4825 KNIGHTSBRIDGE BLVD SUITE A
COLUMBUS OH
43214-2352
US

V. Phone/Fax

Practice location:
  • Phone: 614-459-0216
  • Fax: 614-459-0362
Mailing address:
  • Phone: 614-459-0216
  • Fax: 614-459-0362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberRN.205132
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: