1598946618 NPI number — MARY F MOLLISON CNP

Table of content: MARY F MOLLISON CNP (NPI 1598946618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598946618 NPI number — MARY F MOLLISON CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOLLISON
Provider First Name:
MARY
Provider Middle Name:
F
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:
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:
1598946618
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9702 ACME RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RITTMAN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44270-9623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-336-8737
Provider Business Mailing Address Fax Number:
330-336-8747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RITTMAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44270-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-925-1500
Provider Business Practice Location Address Fax Number:
330-925-9030
Provider Enumeration Date:
11/16/2007

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:  RN223716 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: NP-06992 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SA2200X , with the licence number: NS-05805 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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