Healthcare Provider Details

I. General information

NPI: 1972753010
Provider Name (Legal Business Name): MELISSA PETERS-MARCUS NINES CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA PETERS MARCUS

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 01/25/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3433 AGLER RD SUITE 2800
COLUMBUS OH
43219-3387
US

IV. Provider business mailing address

PO BOX 16370
COLUMBUS OH
43216-6370
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-1600
  • Fax: 614-645-1347
Mailing address:
  • Phone: 614-645-5500
  • Fax: 614-645-5517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.332201-COA1
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number332210
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number10155
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCOA.10155-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: