Provider Demographics
NPI:1558719500
Name:DOUTHWAITE, JENNIFER MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:DOUTHWAITE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1152
Mailing Address - Country:US
Mailing Address - Phone:614-336-6000
Mailing Address - Fax:614-336-6898
Practice Address - Street 1:3990 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1152
Practice Address - Country:US
Practice Address - Phone:614-336-6000
Practice Address - Fax:614-336-6898
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.310046-1163W00000X
OHCOA.18831-NP363LF0000X
OHCTP.18831-EX1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse