Provider Demographics
NPI:1396866208
Name:MICHAEL, MARY A (CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:A
Other - Last Name:SPALLA AND CREIGHTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 11013
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-1422
Mailing Address - Fax:513-636-3220
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 11013
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-1422
Practice Address - Fax:513-636-3220
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.05749-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner