Healthcare Provider Details

I. General information

NPI: 1982210464
Provider Name (Legal Business Name): NICHOLAS ANDREW BROWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6025 MEMORIAL DR
DUBLIN OH
43017-8902
US

IV. Provider business mailing address

6025 MEMORIAL DR
DUBLIN OH
43017-8902
US

V. Phone/Fax

Practice location:
  • Phone: 614-401-6208
  • Fax: 614-964-9120
Mailing address:
  • Phone: 614-401-6208
  • Fax: 614-964-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.026713
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP.026713
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: