Provider Demographics
NPI:1548957327
Name:DIBBLE, MARCUS A II
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:A
Last Name:DIBBLE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-0021
Mailing Address - Country:US
Mailing Address - Phone:231-942-9015
Mailing Address - Fax:
Practice Address - Street 1:3094 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MI
Practice Address - Zip Code:48884-9345
Practice Address - Country:US
Practice Address - Phone:231-942-9112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide