Healthcare Provider Details

I. General information

NPI: 1790187607
Provider Name (Legal Business Name): MARY C WILL CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

1088 MOUNT PLEASANT AVE
COLUMBUS OH
43201-3555
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5200
  • Fax:
Mailing address:
  • Phone: 614-226-5469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.16583
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: