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General NPI Number Information
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NPI Number | 1861082877
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Entity Type | Organization
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Legal Business Name | 3130 MEDICAL, LLC
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Dates
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Enumeration Date | 01/23/2021
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Last Update Date | 01/23/2021
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Provider Practice Location Address
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Address Line | 3130 CENTRAL AVE #23
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City | TOLEDO
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State | OH
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Zip | 43606
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Country | US
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Telephone | 419-531-3698
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Fax |
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Provider Business Mailing Address
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Address Line | 1712 PIONEER AVE STE 500
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City | CHEYENNE
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State | WY
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Zip | 82001
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Country | US
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Telephone | 615-613-3871
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Fax | 855-267-9337
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Authorized Official
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Title or Position | REPRESENTATIVE
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Name | REBECCA MURRAY
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Credential |
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Telephone | 615-613-3871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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