=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194053504
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RITA WEN KASPAR PHD, RN, FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/23/2009
-----------------------------------------------------
Last Update Date | 11/23/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3535 OLENTANGY RIVER RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43214-3908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-566-5000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7883 CALVERTON SQ
-----------------------------------------------------
City | NEW ALBANY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43054-9343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-896-5688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | COA.10913-NP
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------