Healthcare Provider Details

I. General information

NPI: 1285855643
Provider Name (Legal Business Name): MARY ELIZABETH ANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELIZABETH TORRENCE RN

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2057 ZOLLINGER RD
COLUMBUS OH
43221-1927
US

IV. Provider business mailing address

2057 ZOLLINGER RD
COLUMBUS OH
43221-1927
US

V. Phone/Fax

Practice location:
  • Phone: 614-209-6538
  • Fax: 614-487-0747
Mailing address:
  • Phone: 614-209-6538
  • Fax: 614-487-0747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number190964
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: