Provider Demographics
NPI:1326411711
Name:NG, MARCIA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 SOUTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-2738
Mailing Address - Country:US
Mailing Address - Phone:812-371-4292
Mailing Address - Fax:812-371-4292
Practice Address - Street 1:1482 SOUTHSIDE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2738
Practice Address - Country:US
Practice Address - Phone:812-371-4292
Practice Address - Fax:812-371-4292
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28167121A363LF0000X
IN71005935A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily