Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | COA.12554-NP | OH |
NPI | 1104106160 |
---|---|
Provider Name | Mary Beth Marburger |
First Address | Canton, OH 44718-2531 |
Second Address | Canton, OH 44718-2531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2011 |
Last Update Date | 09/03/2016 |