Healthcare Provider Details

I. General information

NPI: 1053192120
Provider Name (Legal Business Name): FAITH AND HOPE CLINICIAN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 APACHE CIR
WESTERVILLE OH
43081-2791
US

IV. Provider business mailing address

PO BOX 86
WESTERVILLE OH
43086-0086
US

V. Phone/Fax

Practice location:
  • Phone: 161-458-1033
  • Fax:
Mailing address:
  • Phone: 614-581-0334
  • Fax: 517-394-4665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANNA HUNG-CHAN
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 614-581-0334