MEDICARE: MARY BINGHAM RN

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN225707	OH

General Provider Information

NPI Number	:	1760918395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY BINGHAM RN

Provider Business Mailing Address
First Line	:	8100 RAVINES EDGE CT STE 200
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5426
Country	:	US
Telephone Number	:	614-985-3112
Fax Number	:	614-410-8827

Provider Business Practice Location Address
First Line	:	8100 RAVINES EDGE CT STE 200
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5426
Country	:	US
Telephone Number	:	614-985-3112
Fax Number	:	614-410-8827

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

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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