Provider Demographics
NPI:1568648293
Name:PHILPOTTS, MARCIA (RN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:
Last Name:PHILPOTTS
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3682 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-2447
Mailing Address - Country:US
Mailing Address - Phone:216-341-4225
Mailing Address - Fax:
Practice Address - Street 1:6100 ROCKSIDE WOODS BLVD N
Practice Address - Street 2:SUITE 425
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2366
Practice Address - Country:US
Practice Address - Phone:216-643-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.257410364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN.257410OtherSTATE NURSING LICENSE