Healthcare Provider Details

I. General information

NPI: 1679454078
Provider Name (Legal Business Name): ANNA NIEDZWIECKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

4135 DAVIDS WAY
PERRY OH
44081-8656
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-2000
  • Fax: 614-722-4440
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010620RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: