MEDICARE: MRS. JENNIFER MARIE DOUTHWAITE NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN.310046-1	OH
2	363LF0000X	Family Nurse Practitioner	COA.18831-NP	OH
3	363LF0000X	Family Nurse Practitioner	CTP.18831-EX1	OH

General Provider Information

NPI Number	:	1558719500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER MARIE DOUTHWAITE NP-C

Provider Business Mailing Address
First Line	:	3990 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1152
Country	:	US
Telephone Number	:	614-336-6000
Fax Number	:	614-336-6898

Provider Business Practice Location Address
First Line	:	3990 E BROAD ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-1152
Country	:	US
Telephone Number	:	614-336-6000
Fax Number	:	614-336-6898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	05/19/2021

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