Provider Demographics
NPI:1760258974
Name:MARBACH, WENDY G
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:G
Last Name:MARBACH
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 1:15151 W CENTERRA DR S
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-2956
Mailing Address - Country:US
Mailing Address - Phone:623-772-4810
Mailing Address - Fax:623-772-4820
Practice Address - Street 1:15151 W CENTERRA DR S
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2956
Practice Address - Country:US
Practice Address - Phone:623-772-4810
Practice Address - Fax:623-772-4820
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97560164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse