Provider Demographics
NPI:1871304931
Name:NTIM, NELLY
Entity type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:NTIM
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1577 NEIL AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2320
Mailing Address - Country:US
Mailing Address - Phone:614-805-6695
Mailing Address - Fax:
Practice Address - Street 1:1577 NEIL AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2320
Practice Address - Country:US
Practice Address - Phone:614-805-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-17
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.531086363LS0200X, 163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program