Healthcare Provider Details

I. General information

NPI: 1154233567
Provider Name (Legal Business Name): DANA MARCUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HIGH ST
CARROLL OH
43112-9018
US

IV. Provider business mailing address

55 HIGH ST
CARROLL OH
43112-9018
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN.393197
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: