Provider Demographics
NPI:1376138073
Name:VIRDEN, NAYRIAH
Entity Type:Individual
Prefix:
First Name:NAYRIAH
Middle Name:
Last Name:VIRDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 MERRIWICK CROSSING DR UNIT 303
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3904
Mailing Address - Country:US
Mailing Address - Phone:419-612-2669
Mailing Address - Fax:
Practice Address - Street 1:1515 INDIANOLA AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2118
Practice Address - Country:US
Practice Address - Phone:419-612-2669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
599294621261OtherMEDICAL MUTUAL