Provider Demographics
NPI:1902670607
Name:JAMES, MARLO
Entity type:Individual
Prefix:
First Name:MARLO
Middle Name:
Last Name:JAMES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 COLUMBUS AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9950
Mailing Address - Country:US
Mailing Address - Phone:513-934-7171
Mailing Address - Fax:513-968-3031
Practice Address - Street 1:1000 COLUMBUS AVE UNIT B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9950
Practice Address - Country:US
Practice Address - Phone:513-934-7171
Practice Address - Fax:513-968-3031
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0035342363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily