Provider Demographics
NPI:1457014599
Name:PROFESSIONAL PROVIDERS NETWORKING LLC
Entity Type:Organization
Organization Name:PROFESSIONAL PROVIDERS NETWORKING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WADEI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN FNP-BC, FNP-C
Authorized Official - Phone:614-574-1823
Mailing Address - Street 1:691 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3209
Mailing Address - Country:US
Mailing Address - Phone:614-599-2479
Mailing Address - Fax:
Practice Address - Street 1:691 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3209
Practice Address - Country:US
Practice Address - Phone:614-599-2479
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-15
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPRN.CNP.0028939OtherMEDICARE
OHAPRN.CNP.0028939Medicaid