Provider Demographics
NPI:1093412744
Name:VENABLE, MARLENE SHERRELL
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:SHERRELL
Last Name:VENABLE
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 1:44 WESTFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-7705
Mailing Address - Country:US
Mailing Address - Phone:919-862-7589
Mailing Address - Fax:
Practice Address - Street 1:103 KILMAYNE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4425
Practice Address - Country:US
Practice Address - Phone:919-862-7589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000048626184342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company