Healthcare Provider Details

I. General information

NPI: 1942448816
Provider Name (Legal Business Name): CONSTANCE ALLYSON NICASTRO-BOWMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 JASONWAY AVE
COLUMBUS OH
43214-2464
US

IV. Provider business mailing address

6868 BRODIE BLVD
DUBLIN OH
43017-8048
US

V. Phone/Fax

Practice location:
  • Phone: 614-538-2250
  • Fax:
Mailing address:
  • Phone: 614-793-9753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10418
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number280716
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: