Provider Demographics
NPI:1639229693
Name:MARION, LARRY E (LPN, CFA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:E
Last Name:MARION
Suffix:
Gender:M
Credentials:LPN, CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 818
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42142-0818
Mailing Address - Country:US
Mailing Address - Phone:270-651-9408
Mailing Address - Fax:270-651-6023
Practice Address - Street 1:1216 B NORTH RACE STREET
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141
Practice Address - Country:US
Practice Address - Phone:270-651-9408
Practice Address - Fax:270-651-6023
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000184701OtherKENTUCKY ACCESS
KY000000184701OtherBLUE CROSS & BLUE SHIELD