Provider Demographics
NPI:1245444603
Name:MCARRELL, BIANCA MELISSA (BA)
Entity type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:MELISSA
Last Name:MCARRELL
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 THURBER DR W APT A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1212
Mailing Address - Country:US
Mailing Address - Phone:614-893-1693
Mailing Address - Fax:
Practice Address - Street 1:722 THURBER DR W APT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1212
Practice Address - Country:US
Practice Address - Phone:614-893-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2366756Medicaid