Basic Information
Provider Information
NPI: 1174964605
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWETNAM
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1144 DUBLIN RD
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432151039
CountryCode: US
TelephoneNumber: 6142340200
FaxNumber:  
Practice Location
Address1: 1144 DUBLIN RD
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432151039
CountryCode: US
TelephoneNumber: 6142340200
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/12/2013
LastUpdateDate: 03/10/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/10/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X14702NPOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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