Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3010571 | KY |
NPI | 1003360264 |
---|---|
Provider Name | Marcia Atherton |
First Address | Gahanna, OH 43230-6696 |
Second Address | Bowling Green, KY 42103-2449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2016 |
Last Update Date | 06/10/2017 |