Provider Demographics
NPI:1376099556
Name:NATIONWIDE CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:NATIONWIDE CHILDREN'S HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATAL NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOSSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NNP-BC
Authorized Official - Phone:614-216-1107
Mailing Address - Street 1:5076 MEDALLION DR W
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9592
Mailing Address - Country:US
Mailing Address - Phone:614-216-1107
Mailing Address - Fax:
Practice Address - Street 1:700 CHILDRENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2664
Practice Address - Country:US
Practice Address - Phone:614-722-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHFOS1-0440-0733282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren