Provider Demographics
NPI:1407087182
Name:DAVIES, MARILYN THERESA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:THERESA
Last Name:DAVIES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27900 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3539
Mailing Address - Country:US
Mailing Address - Phone:216-731-7110
Mailing Address - Fax:216-731-7130
Practice Address - Street 1:27900 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3539
Practice Address - Country:US
Practice Address - Phone:216-731-7110
Practice Address - Fax:216-731-7130
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA10823363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3011896Medicaid
OH3011896Medicaid