Provider Demographics
NPI:1164730651
Name:PRENGUBER, MARCIA ANN (ND)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:ANN
Last Name:PRENGUBER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HIGH PARK AVE
Mailing Address - Street 2:CENTER FOR CANCER CARE
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526
Mailing Address - Country:US
Mailing Address - Phone:574-535-2961
Mailing Address - Fax:574-535-2460
Practice Address - Street 1:200 HIGH PARK AVE
Practice Address - Street 2:CENTER FOR CANCER CARE
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4810
Practice Address - Country:US
Practice Address - Phone:574-535-2961
Practice Address - Fax:574-535-2890
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1082175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath