Provider Demographics
NPI:1689693277
Name:PASSEK, MARTHA K (CNP)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:K
Last Name:PASSEK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6847 N CHESTNUT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3929
Mailing Address - Country:US
Mailing Address - Phone:330-297-6110
Mailing Address - Fax:330-296-0592
Practice Address - Street 1:6847 N CHESTNUT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3929
Practice Address - Country:US
Practice Address - Phone:330-297-6110
Practice Address - Fax:330-296-0592
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHNP07179363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2432871Medicaid
OH2432871Medicaid
OHP98055Medicare UPIN