Provider Demographics
NPI:1760622476
Name:MARSTON, GRACE M (RN)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:M
Last Name:MARSTON
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 1:500 NORTH ST LOT 45
Mailing Address - Street 2:P.O.BOX 786
Mailing Address - City:UTICA
Mailing Address - State:OH
Mailing Address - Zip Code:43080-9760
Mailing Address - Country:US
Mailing Address - Phone:740-892-4994
Mailing Address - Fax:740-892-4994
Practice Address - Street 1:500 NORTH ST LOT 45
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:OH
Practice Address - Zip Code:43080-9760
Practice Address - Country:US
Practice Address - Phone:740-892-4994
Practice Address - Fax:740-892-4994
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN262284163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse