Provider Demographics
NPI:1689693186
Name:FERRANTO, MARY LOU (APRN-BC)
Entity Type:Individual
Prefix:
First Name:MARY LOU
Middle Name:
Last Name:FERRANTO
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 SOUTHWESTERN RUN
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3688
Mailing Address - Country:US
Mailing Address - Phone:330-729-0059
Mailing Address - Fax:330-729-9297
Practice Address - Street 1:807 SOUTHWESTERN RUN
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-3688
Practice Address - Country:US
Practice Address - Phone:330-729-0059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04326363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2490148Medicaid
OH2490148Medicaid