Provider Demographics
NPI:1205292349
Name:TERRELL, MARCIA (LPN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 VANCOUVER DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4748
Mailing Address - Country:US
Mailing Address - Phone:937-972-4502
Mailing Address - Fax:937-278-3923
Practice Address - Street 1:1542 VANCOUVER DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4748
Practice Address - Country:US
Practice Address - Phone:937-972-4502
Practice Address - Fax:937-278-3923
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 125181164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse