Healthcare Provider Details

I. General information

NPI: 1760902092
Provider Name (Legal Business Name): NICOLE MARIE URBANSKI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 E BROAD ST STE 400
COLUMBUS OH
43213-2979
US

IV. Provider business mailing address

6400 E BROAD ST STE 400
COLUMBUS OH
43213-2979
US

V. Phone/Fax

Practice location:
  • Phone: 614-655-3345
  • Fax:
Mailing address:
  • Phone: 614-655-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0036665
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.334794
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: