Healthcare Provider Details

I. General information

NPI: 1679158513
Provider Name (Legal Business Name): JENNIFER OGDEN PRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2021
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 N SANDUSKY ST
DELAWARE OH
43015-1756
US

IV. Provider business mailing address

1791 ALUM CREEK DR
COLUMBUS OH
43207-1757
US

V. Phone/Fax

Practice location:
  • Phone: 740-203-3800
  • Fax:
Mailing address:
  • Phone: 614-445-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0002218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: