Provider Demographics
NPI:1891743449
Name:BECHTEL, MARISSA MARIE (CNP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:MARIE
Last Name:BECHTEL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 LAZELLE RD E
Mailing Address - Street 2:# B
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-8605
Mailing Address - Country:US
Mailing Address - Phone:614-885-3338
Mailing Address - Fax:877-877-4797
Practice Address - Street 1:117 LAZELLE RD E
Practice Address - Street 2:#B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-8605
Practice Address - Country:US
Practice Address - Phone:614-885-3338
Practice Address - Fax:877-877-4797
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA07955NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2529919Medicaid
NP16692Medicare PIN