Provider Demographics
NPI:1801455662
Name:RADER, JAN RENEE (NP-C)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:RENEE
Last Name:RADER
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 1:3661 FISH HAWK LNDG
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6444
Mailing Address - Country:US
Mailing Address - Phone:614-270-6357
Mailing Address - Fax:
Practice Address - Street 1:3661 FISH HAWK LNDG
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6444
Practice Address - Country:US
Practice Address - Phone:614-270-6357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.287948163W00000X
OHAPRN.CNP.024740363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse