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General NPI Number Information
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NPI Number | 1710254610
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Entity Type | Individual
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Provider Name | MARY MADOLYN TRAVER CNP
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Gender | Female
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Dates
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Enumeration Date | 11/19/2011
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 1100 W MAIN ST
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City | WOODVILLE
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State | OH
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Zip | 43469-9723
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Country | US
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Telephone | 419-849-2871
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Fax | 419-849-3865
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Provider Business Mailing Address
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Address Line | 2200 JEFFERSON AVE 5TH FL CREDENTIAING DEPARTMENT
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City | TOLEDO
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State | OH
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Zip | 43604-7101
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN216511-COA1
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License Number State | OH
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