Individual
CAROL DERWACTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.P.
Contact information
Practice address
2945 MAPLE AVE, ZANESVILLE, OH 43701-1753
(740) 454-0196
(740) 454-7834
Mailing address
860 BETHESDA DR, ZANESVILLE, OH 43701-1800
(740) 454-4651
(740) 454-4653
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
NP04044
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080146341
MEDICARE RAILROAD
OH
01
—
0989499
GROUP MEDICAID
OH
05
—
2043354
—
OH
01
—
311413469060
CARESOURCE PIN
OH
01
—
CA1586
GROUP MEDICARE RAILROAD
—
01
—
DENP03501
MEDICARE PTAN
—
Enumeration date
12/19/2005
Last updated
08/19/2008
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