Provider Demographics
NPI:1184814873
Name:SIDANI, CARMEN G (CNP)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:G
Last Name:SIDANI
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 JASONWAY AVE STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4359
Mailing Address - Country:US
Mailing Address - Phone:614-442-3130
Mailing Address - Fax:614-442-3150
Practice Address - Street 1:810 JASONWAY AVE STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4359
Practice Address - Country:US
Practice Address - Phone:614-442-3130
Practice Address - Fax:614-442-3145
Is Sole Proprietor?:No
Enumeration Date:2007-07-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.09527363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3101431Medicaid