Provider Demographics
NPI:1356891006
Name:ANDERSON, MARIAH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:ANDERSON
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 1:2041 HIGHLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:COLLEGE HL
Mailing Address - State:OH
Mailing Address - Zip Code:45224
Mailing Address - Country:US
Mailing Address - Phone:513-591-1559
Mailing Address - Fax:513-591-0014
Practice Address - Street 1:2041 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE HL
Practice Address - State:OH
Practice Address - Zip Code:45224-1821
Practice Address - Country:US
Practice Address - Phone:513-591-1559
Practice Address - Fax:513-591-0014
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401308111011376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide