Individual
JENNIFER DEAN NIEWIADOMSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1313 OLENTANGY RIVER RD, COLUMBUS, OH 43212-3120
(614) 890-6555
(614) 823-8881
Mailing address
6480 HARRISON AVE STE 201, CINCINNATI, OH 45247-7961
(513) 795-4049
(513) 354-7651
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
50.004437
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0145495
—
OH
01
—
H465660
MEDICARE PTAN
OH
Enumeration date
09/28/2015
Last updated
08/08/2023
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