Healthcare Provider Details

I. General information

NPI: 1982103917
Provider Name (Legal Business Name): SHANDY JASPER-WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

9219 INDIAN MOUND RD
PICKERINGTON OH
43147-8895
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5200
  • Fax:
Mailing address:
  • Phone: 614-397-6263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number317450
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: