Healthcare Provider Details

I. General information

NPI: 1003653734
Provider Name (Legal Business Name): NATALIE RAE MARIENTHAL MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W CENTRAL AVE STE 100A
TOLEDO OH
43606-3817
US

IV. Provider business mailing address

1028 STONELEIGH RD
PERRYSBURG OH
43551-1301
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-8400
  • Fax:
Mailing address:
  • Phone: 815-985-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0037053
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAPRN.CNP.0037053
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: