Healthcare Provider Details

I. General information

NPI: 1457562506
Provider Name (Legal Business Name): MRS. JOANNE A TRABOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6406 DEER RIDGE LN
COLUMBUS OH
43229-2014
US

IV. Provider business mailing address

6406 DEER RIDGE LN
COLUMBUS OH
43229-2014
US

V. Phone/Fax

Practice location:
  • Phone: 614-895-7305
  • Fax: 614-899-9334
Mailing address:
  • Phone: 614-895-7305
  • Fax: 614-899-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN182593
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: