Healthcare Provider Details

I. General information

NPI: 1992117956
Provider Name (Legal Business Name): JENNIFER M VIRAG CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N 1ST ST
DENNISON OH
44621-1003
US

IV. Provider business mailing address

819 N 1ST ST
DENNISON OH
44621-1003
US

V. Phone/Fax

Practice location:
  • Phone: 740-922-0000
  • Fax: 740-922-7408
Mailing address:
  • Phone: 740-922-0000
  • Fax: 740-922-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberCOA.15909-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.15909-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: