Provider Demographics
NPI:1730074634
Name:COLVIN, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:COLVIN
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 1:2939 JEFFERSON ST # 323
Mailing Address - Street 2:
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-9702
Mailing Address - Country:US
Mailing Address - Phone:440-990-9950
Mailing Address - Fax:
Practice Address - Street 1:2939 JEFFERSON ST # 323
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9702
Practice Address - Country:US
Practice Address - Phone:440-990-9950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker