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General NPI Number Information
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NPI Number | 1437298999
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Entity Type | Organization
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Legal Business Name | EASTSIDE FAMILY PRACTICE, INC.
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11299 STONECREEK DR
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City | PICKERINGTON
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State | OH
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Zip | 43147-8910
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Country | US
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Telephone | 614-235-4782
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Fax |
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Provider Business Mailing Address
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Address Line | 1835 DRUGAN CT SW
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-8181
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Country | US
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Telephone | 614-864-6107
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NANCY L. GRAESSER
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Credential | D.O.
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Telephone | 614-864-6107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34004238
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License Number State | OH
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