Healthcare Provider Details

I. General information

NPI: 1043747173
Provider Name (Legal Business Name): ANGELA NICOLE WITHERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 05/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 GODOWN RD
COLUMBUS OH
43220-2660
US

IV. Provider business mailing address

5050 GODOWN RD
COLUMBUS OH
43220-2660
US

V. Phone/Fax

Practice location:
  • Phone: 614-354-1625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number421388
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: