MEDICARE: CHIONISO MAREYA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN383636	OH

General Provider Information

NPI Number	:	1023603198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIONISO MAREYA

Provider Business Mailing Address
First Line	:	8111 ROYAL ELM DR
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-5054
Country	:	US
Telephone Number	:	614-377-6053
Fax Number	:

Provider Business Practice Location Address
First Line	:	8111 ROYAL ELM DR
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-5054
Country	:	US
Telephone Number	:	614-377-6053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2021
Last Update Date	:	03/01/2021

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Directions to “ CHIONISO MAREYA ” Practice Location

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