Healthcare Provider Details

I. General information

NPI: 1568055598
Provider Name (Legal Business Name): WILLIAM ROBERT MACOMBER MSN, APRN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2021
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date: 02/20/2021
Reactivation Date: 04/13/2023

III. Provider practice location address

6480 ROCKSIDE WOODS BLVD S STE 330
INDEPENDENCE OH
44131-2222
US

IV. Provider business mailing address

6480 ROCKSIDE WOODS BLVD S STE 330
INDEPENDENCE OH
44131-2222
US

V. Phone/Fax

Practice location:
  • Phone: 855-490-9434
  • Fax:
Mailing address:
  • Phone: 855-490-9434
  • Fax: 216-238-9526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number42024
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number677810
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0030174
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: