Healthcare Provider Details

I. General information

NPI: 1194443291
Provider Name (Legal Business Name): NICHOLAS RANDOLPH TROSTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 WOODY HAYES DR
COLUMBUS OH
43210-1104
US

IV. Provider business mailing address

1087 LAKE PT
WESTERVILLE OH
43082-7473
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-6330
  • Fax:
Mailing address:
  • Phone: 614-907-5798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: