1972753010 NPI number — MELISSA PETERS-MARCUS NINES CNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972753010 NPI number — MELISSA PETERS-MARCUS NINES CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NINES
Provider First Name:
MELISSA
Provider Middle Name:
PETERS-MARCUS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARCUS
Provider Other First Name:
MELISSA
Provider Other Middle Name:
PETERS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972753010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43216-6370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-645-5500
Provider Business Mailing Address Fax Number:
614-645-5517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3433 AGLER RD
Provider Second Line Business Practice Location Address:
SUITE 2800
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43219-3387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-645-1600
Provider Business Practice Location Address Fax Number:
614-645-1347
Provider Enumeration Date:
09/25/2008

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: 163W00000X , with the licence number:  RN.332201-COA1 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 332210 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: 10155 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LW0102X , with the licence number: COA.10155-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: 2935140 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".