Healthcare Provider Details

I. General information

NPI: 1073627485
Provider Name (Legal Business Name): MARIAN WILSON ROWLAND APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 S OCOEE ST
CLEVELAND TN
37311-2601
US

IV. Provider business mailing address

940 S OCOEE ST
CLEVELAND TN
37311-2601
US

V. Phone/Fax

Practice location:
  • Phone: 423-479-5454
  • Fax: 423-339-3421
Mailing address:
  • Phone: 423-479-5454
  • Fax: 423-339-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number128026
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number128935
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14993
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG128935
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: