Provider Demographics
NPI:1881974301
Name:MOUNTS, MARIAN M
Entity type:Individual
Prefix:MISS
First Name:MARIAN
Middle Name:M
Last Name:MOUNTS
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 1:600 PINE HOLLOW BLVD APT 106
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3002
Mailing Address - Country:US
Mailing Address - Phone:440-714-6550
Mailing Address - Fax:440-240-8219
Practice Address - Street 1:600 PINE HOLLOW BLVD APT 106
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3002
Practice Address - Country:US
Practice Address - Phone:440-714-6550
Practice Address - Fax:440-240-8219
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN088899164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse