Healthcare Provider Details

I. General information

NPI: 1922360643
Provider Name (Legal Business Name): MARLENE ANGEL FUSON N.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4702 5TH STREET ROAD
CORBIN KY
40701
US

IV. Provider business mailing address

1548 HIGHTOP RD
CORBIN KY
40701-9560
US

V. Phone/Fax

Practice location:
  • Phone: 606-261-6278
  • Fax:
Mailing address:
  • Phone: 606-304-5008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: