Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | APRN.CNP.021120 | OH |
NPI | 1003337742 |
---|---|
Provider Name | Mrs. Brittany Mawer |
First Address | Van Wert, OH 45891-2464 |
Second Address | Van Wert, OH 45891-2464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2017 |
Last Update Date | 24/07/2017 |