Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 35.047498 | OH |
NPI | 1164491163 |
---|---|
Provider Name | Mary Ellen Wissel |
First Address | Columbus, OH 43205-1322 |
Second Address | Columbus, OH 43205-1322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0149011 | (05) | OH |
G03877 | (02) | OH |