Provider Demographics
NPI:1346793981
Name:CASBARRO, MARY E (APRN-CNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:CASBARRO
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MOUNT CARMEL MALL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1553
Mailing Address - Country:US
Mailing Address - Phone:614-434-2444
Mailing Address - Fax:
Practice Address - Street 1:54 W HIGH ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1075
Practice Address - Country:US
Practice Address - Phone:614-434-2444
Practice Address - Fax:614-434-2491
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019634363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165048Medicaid