Provider Demographics
NPI:1679800395
Name:MARCUM, BRENDA LEE (CFNP)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:LEE
Last Name:MARCUM
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 E 2ND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3602
Mailing Address - Country:US
Mailing Address - Phone:304-235-2930
Mailing Address - Fax:304-235-2933
Practice Address - Street 1:184 E 2ND AVE STE 1
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3602
Practice Address - Country:US
Practice Address - Phone:304-235-2930
Practice Address - Fax:304-235-2933
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV46089363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV1126AMedicare PIN