Provider Demographics
NPI:1932148657
Name:CURTIS, MARK A (CNS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:CURTIS
Suffix:
Gender:M
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:180 E SPRING VALLEY RD
Mailing Address - Street 2:STE B
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-3803
Mailing Address - Country:US
Mailing Address - Phone:937-291-1351
Mailing Address - Fax:937-291-1719
Practice Address - Street 1:180 E SPRING VALLEY RD
Practice Address - Street 2:STE B
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3803
Practice Address - Country:US
Practice Address - Phone:937-291-1351
Practice Address - Fax:937-291-1719
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS00913364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCUNS03371Medicare ID - Type Unspecified
OHQ57973Medicare UPIN