Provider Demographics
NPI:1740763887
Name:STAMBAUGH, MARCIA (RN)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:STAMBAUGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BERKELEY COUNTY BOARD OF EDUCAITON
Mailing Address - Street 2:1453 WINCHESTER AVENUE
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405
Mailing Address - Country:US
Mailing Address - Phone:304-267-3259
Mailing Address - Fax:304-267-3599
Practice Address - Street 1:BERKELEY COUNTY BOARD OF EDUCATION
Practice Address - Street 2:1453 WINCHESTER AVENUE
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405
Practice Address - Country:US
Practice Address - Phone:304-267-3595
Practice Address - Fax:304-267-3599
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV88652163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV85652OtherWEST VIRGINIA BOARD OF EXAMINERS