Healthcare Provider Details

I. General information

NPI: 1558719500
Provider Name (Legal Business Name): JENNIFER MARIE DOUTHWAITE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 E BROAD ST
COLUMBUS OH
43213-1152
US

IV. Provider business mailing address

3990 E BROAD ST
COLUMBUS OH
43213-1152
US

V. Phone/Fax

Practice location:
  • Phone: 614-336-6000
  • Fax: 614-336-6898
Mailing address:
  • Phone: 614-336-6000
  • Fax: 614-336-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.18831-NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCTP.18831-EX1
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.310046-1
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: