Provider Demographics
NPI:1811399637
Name:GARRETT, MARY LYNNE
Entity Type:Individual
Prefix:
First Name:MARY LYNNE
Middle Name:
Last Name:GARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5697 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44216-9330
Mailing Address - Country:US
Mailing Address - Phone:330-338-2864
Mailing Address - Fax:
Practice Address - Street 1:1397 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2238
Practice Address - Country:US
Practice Address - Phone:740-623-4382
Practice Address - Fax:740-622-1283
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA16565NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner