Healthcare Provider Details

I. General information

NPI: 1649794553
Provider Name (Legal Business Name): AMBER LAYNE NIKOLAUS APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 UNIVERSITY BLVD STE 3D
DUBLIN OH
43016-3508
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-685-4614
  • Fax: 614-685-5025
Mailing address:
  • Phone: 614-685-4614
  • Fax: 614-685-5025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06171446
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021093
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.021093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: