Healthcare Provider Details

I. General information

NPI: 1629521513
Provider Name (Legal Business Name): AUDREY J SLEESMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY AZIYU

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 KENNY RD FL 8
COLUMBUS OH
43221-3502
US

IV. Provider business mailing address

700 ACKERMAN RD STE 570
COLUMBUS OH
43202-1579
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-6255
  • Fax: 614-293-8518
Mailing address:
  • Phone: 614-293-2594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19160
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.19160
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number423829
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: