Provider Demographics
NPI:1457554800
Name:MARZALIK, PENNY RALL (APRNCNM, PHD, IBCLC)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:RALL
Last Name:MARZALIK
Suffix:
Gender:F
Credentials:APRNCNM, PHD, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 570
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1579
Mailing Address - Country:US
Mailing Address - Phone:614-293-2700
Mailing Address - Fax:614-293-2720
Practice Address - Street 1:2231 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201
Practice Address - Country:US
Practice Address - Phone:614-293-2700
Practice Address - Fax:614-293-2720
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000977367A00000X
OHAPRN.CNM.11539367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife