Healthcare Provider Details

I. General information

NPI: 1164061552
Provider Name (Legal Business Name): MARGORY ANN DHEEL APRN.NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W SUNSET DR
RITTMAN OH
44270-1324
US

IV. Provider business mailing address

222 W SUNSET DR
RITTMAN OH
44270-1324
US

V. Phone/Fax

Practice location:
  • Phone: 330-347-5105
  • Fax:
Mailing address:
  • Phone: 330-347-5105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025765
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: