Healthcare Provider Details

I. General information

NPI: 1952846925
Provider Name (Legal Business Name): GRACE WIREDU CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 E MAIN ST
COLUMBUS OH
43213-2440
US

IV. Provider business mailing address

5000 E MAIN ST
COLUMBUS OH
43213-2440
US

V. Phone/Fax

Practice location:
  • Phone: 614-235-5555
  • Fax: 614-536-1994
Mailing address:
  • Phone: 614-235-5555
  • Fax: 614-536-1994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020110
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: