Healthcare Provider Details

I. General information

NPI: 1255986444
Provider Name (Legal Business Name): DREW DZURKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2491 OLENTANGY RIVER RD
COLUMBUS OH
43210-1031
US

IV. Provider business mailing address

230 WEST 10TH AVE 330 RESIDENCE ON TENTH
COLUMBUS OH
43210-2376
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-2531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: