Basic Information
| Provider Information | |||||||||
| NPI: | 1104106160 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARBURGER | ||||||||
| FirstName: | MARY BETH | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4151 HOLIDAY ST NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304928001 | ||||||||
| FaxNumber: | 3304922080 | ||||||||
| Practice Location | |||||||||
| Address1: | 4151 HOLIDAY ST NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447182531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304928001 | ||||||||
| FaxNumber: | 3304922080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2011 | ||||||||
| LastUpdateDate: | 03/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | COA.12554-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.