Healthcare Provider Details

I. General information

NPI: 1679860159
Provider Name (Legal Business Name): ELIZABETH A THEADO RN, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2011
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

1678 DOLLIVOR DR
COLUMBUS OH
43235-1106
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-4654
  • Fax:
Mailing address:
  • Phone: 614-353-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number316344
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAPRN.CNP.12547
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN.CNP.12547
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: