Healthcare Provider Details

I. General information

NPI: 1699928747
Provider Name (Legal Business Name): PHILIP MOROVIA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2008
Last Update Date: 11/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 WALLCREST BLVD
COLUMBUS OH
43231-4886
US

IV. Provider business mailing address

2665 WALLCREST BLVD
COLUMBUS OH
43231-4886
US

V. Phone/Fax

Practice location:
  • Phone: 614-271-2436
  • Fax:
Mailing address:
  • Phone: 614-271-2436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN . 328676
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: