Individual
MRS. DEBRA VICKERS MARSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3200 MACCORKLE AVE SE, CHAS, WV 25304
(304) 388-4077
(304) 388-9852
Mailing address
519 WOODBRIDGE DRIVE, CHARLESTON, WV 25311
(304) 347-4114
(304) 347-4114
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26614
WV
367500000X
Certified Registered Nurse Anesthetist
Primary
034015
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0065461000
—
WV
01
—
430069471
MEDICARE RR
WV
Enumeration date
10/24/2006
Last updated
04/25/2017
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