Provider Demographics
NPI:1164021101
Name:NOLBERT, MARQUETTA (PHLEBOTOMY)
Entity Type:Individual
Prefix:MRS
First Name:MARQUETTA
Middle Name:
Last Name:NOLBERT
Suffix:
Gender:F
Credentials:PHLEBOTOMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SYLVIA DR APT R4
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-5901
Mailing Address - Country:US
Mailing Address - Phone:404-861-9991
Mailing Address - Fax:
Practice Address - Street 1:665 CASTLEBROOKE WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2665
Practice Address - Country:US
Practice Address - Phone:470-377-3353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty