1114077740 NPI number — BETTY Y MARKER C-FNP

Table of content: BETTY Y MARKER C-FNP (NPI 1114077740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114077740 NPI number — BETTY Y MARKER C-FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKER
Provider First Name:
BETTY
Provider Middle Name:
Y
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C-FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YOLCH
Provider Other First Name:
BETTY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114077740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6691
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-0913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-233-2455
Provider Business Mailing Address Fax Number:
304-233-6073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
69 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26070-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-737-0321
Provider Business Practice Location Address Fax Number:
304-737-2979
Provider Enumeration Date:
01/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  48349 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1026733240001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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