Provider Demographics
NPI:1861980674
Name:GRABAU, MARCIA WILSON
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:WILSON
Last Name:GRABAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 BENFIELD BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-2644
Mailing Address - Country:US
Mailing Address - Phone:443-274-3071
Mailing Address - Fax:886-833-3430
Practice Address - Street 1:1110 BENFIELD BLVD STE F
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-2644
Practice Address - Country:US
Practice Address - Phone:443-274-3071
Practice Address - Fax:886-833-3430
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208710163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health