Healthcare Provider Details

I. General information

NPI: 1760918395
Provider Name (Legal Business Name): MARY BINGHAM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 RAVINES EDGE CT STE 200
COLUMBUS OH
43235-5426
US

IV. Provider business mailing address

8100 RAVINES EDGE CT STE 200
COLUMBUS OH
43235-5426
US

V. Phone/Fax

Practice location:
  • Phone: 614-985-3112
  • Fax: 614-410-8827
Mailing address:
  • Phone: 614-985-3112
  • Fax: 614-410-8827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN225707
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: