Healthcare Provider Details

I. General information

NPI: 1407163629
Provider Name (Legal Business Name): THERESA L. DIBLE APRN-CNP, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ZOLLINGER RD
COLUMBUS OH
43221-2849
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-2076
  • Fax: 614-366-0094
Mailing address:
  • Phone: 614-293-2076
  • Fax: 614-366-0094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.17406
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: