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NPI Code Detail

MEDICARE: MARK GARRETSON PMHNP-BC, APRN

MEDICARE: MARK GARRETSON PMHNP-BC, APRN
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
1363LP0808XPsychiatric/Mental Health Nurse PractitionerAPRN.CNP.022430OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1APRN.CNP.022430OTHEROHOHIO ELICENSE OHIO PROFESSIONAL LICENSURE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538694617
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK GARRETSON PMHNP-BC, APRN
Provider Business Mailing Address
First Line : 1000 S CLEVELAND MASSILLON RD STE 1
Second Line :
City : FAIRLAWN
State : OH
Zip : 44333-9204
Country : US
Telephone Number : 330-754-4844
Fax Number : 833-974-2062
Provider Business Practice Location Address
First Line : 1000 S CLEVELAND MASSILLON RD STE 1
Second Line :
City : FAIRLAWN
State : OH
Zip : 44333-9204
Country : US
Telephone Number : 330-754-4844
Fax Number : 833-974-2062
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2017
Last Update Date : 04/13/2026

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