Healthcare Provider Details

I. General information

NPI: 1194166447
Provider Name (Legal Business Name): AMIE FRUSH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E BROAD ST
COLUMBUS OH
43213-1502
US

IV. Provider business mailing address

5640 HOOVER RD
GROVE CITY OH
43123-9116
US

V. Phone/Fax

Practice location:
  • Phone: 614-832-7300
  • Fax:
Mailing address:
  • Phone: 614-875-2802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.14670-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: