Healthcare Provider Details

I. General information

NPI: 1508689761
Provider Name (Legal Business Name): ELIZABETH SOMALA-ANG ZINANIBE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2024
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 RAAB ST
PICKERINGTON OH
43147-2084
US

IV. Provider business mailing address

618 RAAB ST
PICKERINGTON OH
43147-2084
US

V. Phone/Fax

Practice location:
  • Phone: 614-589-8671
  • Fax:
Mailing address:
  • Phone: 614-589-8671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2024030557
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: