Healthcare Provider Details

I. General information

NPI: 1508474495
Provider Name (Legal Business Name): MARIEA DAWN WEBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CAPITOL ST STE 1610
CHARLESTON WV
25301-1737
US

IV. Provider business mailing address

300 CAPITOL ST STE 1610
CHARLESTON WV
25301-1737
US

V. Phone/Fax

Practice location:
  • Phone: 681-313-8911
  • Fax:
Mailing address:
  • Phone: 681-313-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number1234567
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: