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General NPI Number Information
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NPI Number | 1144538885
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Entity Type | Individual
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Provider Name | ANJA VESANEN BROKAW NP-C
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Gender | Female
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 08/08/2014
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Provider Practice Location Address
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Address Line | 1160 W BROAD ST LOWER LIGHTS CHRISTIAN HEALTH CENTER
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City | COLUMBUS
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State | OH
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Zip | 43222-1317
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Country | US
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Telephone | 614-274-1455
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Fax | 614-274-2040
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Provider Business Mailing Address
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Address Line | 1160 W BROAD ST LOWER LIGHTS CHRISTIAN HEALTH CENTER
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City | COLUMBUS
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State | OH
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Zip | 43222-1317
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Country | US
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Telephone | 614-274-1455
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Fax | 614-274-2040
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN.394211-COA1
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | COA.11799-NP
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License Number State | OH
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