Healthcare Provider Details

I. General information

NPI: 1861167280
Provider Name (Legal Business Name): MIKAL BAHTA SALEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 AIRPORT DR
COLUMBUS OH
43219-2289
US

IV. Provider business mailing address

2017 WATERBROOK LN
COLUMBUS OH
43209-3336
US

V. Phone/Fax

Practice location:
  • Phone: 614-859-1939
  • Fax:
Mailing address:
  • Phone: 614-679-4533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0029458
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: