Healthcare Provider Details

I. General information

NPI: 1093652109
Provider Name (Legal Business Name): ANDREA SPAULDING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 CLEVELAND AVE
COLUMBUS OH
43215-2164
US

IV. Provider business mailing address

430 CLEVELAND AVE
COLUMBUS OH
43215-2164
US

V. Phone/Fax

Practice location:
  • Phone: 380-997-6742
  • Fax: 614-365-8745
Mailing address:
  • Phone: 380-997-6742
  • Fax: 614-365-8745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.339542
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: