Provider Demographics
NPI:1326298068
Name:MARLEAU-WEBB, AVIS G
Entity Type:Individual
Prefix:
First Name:AVIS
Middle Name:G
Last Name:MARLEAU-WEBB
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 1:113 ELLINGTON BLVD APT 539
Mailing Address - Street 2:APT 539
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4542
Mailing Address - Country:US
Mailing Address - Phone:215-796-4827
Mailing Address - Fax:
Practice Address - Street 1:113 ELLINGTON BLVD
Practice Address - Street 2:APT 539
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-4528
Practice Address - Country:US
Practice Address - Phone:215-796-4827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1029207367500000X
MDR205881367500000X
PARN534520367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered