Healthcare Provider Details

I. General information

NPI: 1518692607
Provider Name (Legal Business Name): JAMIE LEANNE NIHISER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N EWING ST
LANCASTER OH
43130-3372
US

IV. Provider business mailing address

11002 FRASURE HELBER RD
LOGAN OH
43138-9583
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-8000
  • Fax:
Mailing address:
  • Phone: 740-279-6484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0029969
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: