Basic Information
Provider Information
NPI: 1083265938
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARLOW
FirstName: BRITTANY
MiddleName: RAE
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 449
Address2:  
City: MARIETTA
State: OH
PostalCode: 457500449
CountryCode: US
TelephoneNumber: 7403744500
FaxNumber:  
Practice Location
Address1: 400 MATTHEW ST STE 210
Address2:  
City: MARIETTA
State: OH
PostalCode: 457501656
CountryCode: US
TelephoneNumber: 7403735410
FaxNumber: 7403735470
Other Information
ProviderEnumerationDate: 09/23/2019
LastUpdateDate: 07/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN.CNP.025588OHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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