Basic Information
Provider Information | |||||||||
NPI: | 1194138370 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | WARDRIP | ||||||||
FirstName: | TISHA | ||||||||
MiddleName: | NIKOLE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MORROW | ||||||||
OtherFirstName: | TISHA | ||||||||
OtherMiddleName: | NIKOLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 945 BETHESDA DR | ||||||||
Address2: | SUITE 200 | ||||||||
City: | ZANESVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 437010801 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7404544788 | ||||||||
FaxNumber: | 7404506157 | ||||||||
Practice Location | |||||||||
Address1: | 751 FOREST AVE | ||||||||
Address2: | SUITE 202 | ||||||||
City: | ZANESVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 437012868 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7405889120 | ||||||||
FaxNumber: | 7405889140 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/05/2014 | ||||||||
LastUpdateDate: | 03/05/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA16026-NP | OH | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.