Provider Demographics
NPI:1629521513
Name:SLEESMAN, AUDREY J (CNP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:J
Last Name:SLEESMAN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:
Other - Last Name:AZIYU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 570
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1579
Mailing Address - Country:US
Mailing Address - Phone:614-293-2594
Mailing Address - Fax:
Practice Address - Street 1:2050 KENNY RD FL 8
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-6255
Practice Address - Fax:614-293-8518
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH423829163W00000X
OH19160363LF0000X
OHAPRN.CNP.19160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0190842Medicaid