Healthcare Provider Details

I. General information

NPI: 1215405691
Provider Name (Legal Business Name): MARY E ALTIERO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 MOUNTVIEW RD
COLUMBUS OH
43221
US

IV. Provider business mailing address

3041 MOUNTVIEW RD
COLUMBUS OH
43221-2747
US

V. Phone/Fax

Practice location:
  • Phone: 614-395-6310
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.024245
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number373025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: