Healthcare Provider Details

I. General information

NPI: 1487958302
Provider Name (Legal Business Name): ELIZABETH A. WADEI APRN FNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2011
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-3209
US

IV. Provider business mailing address

691 E DUBLIN GRANVILLE RD
COLUMBUS OH
43229-3209
US

V. Phone/Fax

Practice location:
  • Phone: 614-574-1823
  • Fax: 614-420-2229
Mailing address:
  • Phone: 614-574-1823
  • Fax: 614-420-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0028939
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN.CNP.0028939
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: