Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | COA 18253 NP | OH |
NPI | 1003281551 |
---|---|
Provider Name | Mrs. Marina Eller |
First Address | Pataskala, OH 43062-8502 |
Second Address | Canal Winchester, OH 43110-8679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2015 |
Last Update Date | 04/07/2019 |