Provider Demographics
NPI:1407600992
Name:PROWS, MARIAH LYNN
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:LYNN
Last Name:PROWS
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 1:463 TULIP RD
Mailing Address - Street 2:
Mailing Address - City:MEDWAY
Mailing Address - State:OH
Mailing Address - Zip Code:45341-1555
Mailing Address - Country:US
Mailing Address - Phone:606-407-7808
Mailing Address - Fax:
Practice Address - Street 1:463 TULIP RD
Practice Address - Street 2:
Practice Address - City:MEDWAY
Practice Address - State:OH
Practice Address - Zip Code:45341-1555
Practice Address - Country:US
Practice Address - Phone:606-407-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6024954108223747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant