Healthcare Provider Details

I. General information

NPI: 1700877644
Provider Name (Legal Business Name): DEBORAH L MARRA CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 HARPER RD STE 102
BECKLEY WV
25801-3376
US

IV. Provider business mailing address

321 S EISENHOWER DR
BECKLEY WV
25801-5849
US

V. Phone/Fax

Practice location:
  • Phone: 304-252-9211
  • Fax: 304-252-9218
Mailing address:
  • Phone: 304-256-6500
  • Fax: 304-929-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24494
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: