1356624118 NPI number — ROBIN MARR ANP-BC

Table of content: ROBIN MARR ANP-BC (NPI 1356624118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356624118 NPI number — ROBIN MARR ANP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARR
Provider First Name:
ROBIN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356624118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2790 SILVER FOX DR. SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WARREN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44481-9236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-824-3296
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6847 N. CHESTNUT STREET
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
RAVENNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-296-2819
Provider Business Practice Location Address Fax Number:
330-296-9503
Provider Enumeration Date:
09/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  COA 12302-NP , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RN-193331 . This is a "RN LICENSE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: COA-12302-NP . This is a "COA NP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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