Unknown Individual – Family Nurse Practitioner, NPI 1790822948

Family Nurse Practitioner

Unknown Individual is a healthcare provider. based in Oregon, Ohio. specializing in Family Nurse Practitioner. They hold a License No. NP09062 (OH). The NPI Number for Unknown Individual is 1790822948

Main info

Organization

Inactive

31 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1790822948

Phone

(419) 691-0636

Address

3232 NAVARRE AVE

Deactivation Date

7 August 2024

Doctor Profile

Medical School Name

OTHER

Secondary Phone

4198725343

Graduation Year

1995 (31 years ago)

PAC ID

8123199403

Group Practice PAC ID

9830131382

Professional Enrollment ID

I20080613000097

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience23

Completeness75

Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

3232, Navarre Avenue, Szabo Addition, Oregon, Lucas County, Ohio, 43616, United States
OREGON, OH 436163312
Phone: (419) 691-0636
Type: Location
533, Southfield Drive, Maumee, Lucas County, Ohio, 43537, United States
MAUMEE, OH 435372707
Phone: (419) 893-4672
Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 43616)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.

PAC ID: 9830131382View full group profile

Name	Specialty	State
MRS. GINA MARIE MUSA (CNP)	-	OH
MARC M. CRISENBERY (NP)	Nurse Practitioner	OH
MRS. SARAH BORIS (APRN)	Nurse Practitioner	OH

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?

CMS-hosted NPPES data lists Unknown Individual with NPI 1790822948.

Is Unknown Individual excluded from programs when inactive?

The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Family Nurse Practitioner in this dataset. Clinical services aligned with this taxonomy classification.

What address line appears for Unknown Individual?

Unknown Individual's geographic hint is Oregon, Ohio in our summary view.

Is specialty guaranteed by NPI alone?

Taxonomy selections describe intent; scope of practice still follows state law.