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General NPI Number Information
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NPI Number | 1922971035
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 7602 SLATE RIDGE BLVD
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-8157
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Country | US
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Telephone | 614-446-0101
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Fax | 614-420-2229
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Provider Business Mailing Address
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Address Line | 7602 SLATE RIDGE BLVD
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City | REYNOLDSBURG
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State | OH
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Zip | 43068-8157
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Country | US
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Telephone | 614-446-0101
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Fax | 614-420-2229
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Authorized Official
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Title or Position | CEO
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Name | ELIZABETH ASANTEWA WADEI
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Credential | CNP
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Telephone | 614-446-0101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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