1972753010 NPI number — MELISSA PETERS-MARCUS NINES CNP

Table of content: MELISSA PETERS-MARCUS NINES CNP (NPI 1972753010)

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".