Healthcare Provider Details

I. General information

NPI: 1215980800
Provider Name (Legal Business Name): NAOMI FAYE WRISTON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6760 A AVERY-MUIRFIELD DRIVE
DUBLIN OH
43017
US

IV. Provider business mailing address

PO BOX 550
LANCASTER OH
43130-0550
US

V. Phone/Fax

Practice location:
  • Phone: 614-791-9952
  • Fax: 614-791-9953
Mailing address:
  • Phone: 740-687-5164
  • Fax: 740-654-1417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34002932
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: