Provider Demographics
NPI:1568055598
Name:MACOMBER, WILLIAM ROBERT (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:MACOMBER
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 ROCKSIDE WOODS BLVD S STE 330
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-2222
Mailing Address - Country:US
Mailing Address - Phone:855-490-9434
Mailing Address - Fax:216-238-9526
Practice Address - Street 1:6480 ROCKSIDE WOODS BLVD S STE 330
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2222
Practice Address - Country:US
Practice Address - Phone:855-490-9434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-20
Last Update Date:2023-07-06
Deactivation Date:2021-02-20
Deactivation Code:
Reactivation Date:2023-04-13
Provider Licenses
StateLicense IDTaxonomies
OH42024163W00000X
PA677810163W00000X
OHAPRN.CNP.0030174363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse