Provider Demographics
NPI:1902921372
Name:DEBARBADILLO, MARIANNE KATHRYN (BC-FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNE
Middle Name:KATHRYN
Last Name:DEBARBADILLO
Suffix:
Gender:F
Credentials:BC-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 WATER ST # A
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1929
Mailing Address - Country:US
Mailing Address - Phone:304-733-2930
Mailing Address - Fax:304-736-5984
Practice Address - Street 1:5933 E PEA RIDGE RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2629
Practice Address - Country:US
Practice Address - Phone:304-736-6262
Practice Address - Fax:304-736-5984
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-00372363LF0000X
WV35013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2085792Medicaid
OH2085792Medicaid
OHDENP02596Medicare PIN