Provider Demographics
NPI:1629067905
Name:CULBERTSON, MARION LORRAINE (NP)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:LORRAINE
Last Name:CULBERTSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26104-2519
Mailing Address - Country:US
Mailing Address - Phone:304-428-1900
Mailing Address - Fax:304-428-1976
Practice Address - Street 1:2910 EMERSON AVE
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-2519
Practice Address - Country:US
Practice Address - Phone:304-428-1900
Practice Address - Fax:304-428-1976
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV42604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH054/8956Medicaid
WV0049665000Medicaid
WV0049665000Medicaid
P29147Medicare UPIN