Healthcare Provider Details

I. General information

NPI: 1659892537
Provider Name (Legal Business Name): JENNIFER MARIE VAN FOSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MOUNT CARMEL MEDICAL GROUP 10330 SAWMILL PARKWAY SUITE 600
POWELL OH
43065
US

IV. Provider business mailing address

10330 SAWMILL PKWY STE 600
POWELL OH
43065-7796
US

V. Phone/Fax

Practice location:
  • Phone: 614-627-1850
  • Fax: 614-760-5985
Mailing address:
  • Phone: 614-627-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1069884
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number021208
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1069884
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number381869
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: