Provider Demographics
NPI:1619083136
Name:MARINUS, MARY BETH (CFNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:MARINUS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 HOLSTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4486
Mailing Address - Country:US
Mailing Address - Phone:276-223-0460
Mailing Address - Fax:276-223-0466
Practice Address - Street 1:245 HOLSTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4486
Practice Address - Country:US
Practice Address - Phone:276-223-0460
Practice Address - Fax:276-223-0466
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24164760363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner