Individual
MR. MARCUS WAYNE THREADGILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
205 E WILDEY ST, PHILADELPHIA, PA 19125-4136
(215) 687-7620
Mailing address
205 E WILDEY ST, PHILADELPHIA, PA 19125-4136
(215) 687-7620
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN589196
PA
Other
Enumeration date
08/15/2008
Last updated
08/15/2008
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