Healthcare Provider Details

I. General information

NPI: 1629067905
Provider Name (Legal Business Name): MARION LORRAINE CULBERTSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 EMERSON AVE
PARKERSBURG WV
26104-2519
US

IV. Provider business mailing address

2910 EMERSON AVE
PARKERSBURG WV
26104-2519
US

V. Phone/Fax

Practice location:
  • Phone: 304-428-1900
  • Fax: 304-428-1976
Mailing address:
  • Phone: 304-428-1900
  • Fax: 304-428-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberWV42604
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: