Provider Demographics
NPI:1770817546
Name:MARBLE, SHERALYN THOMPSON (RN)
Entity Type:Individual
Prefix:
First Name:SHERALYN
Middle Name:THOMPSON
Last Name:MARBLE
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 1:10 PINECONE DRAW
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9755
Mailing Address - Country:US
Mailing Address - Phone:406-422-0390
Mailing Address - Fax:
Practice Address - Street 1:10 PINECONE DRAW
Practice Address - Street 2:
Practice Address - City:CLANCY
Practice Address - State:MT
Practice Address - Zip Code:59634-9755
Practice Address - Country:US
Practice Address - Phone:406-422-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT33978163W00000X
WY23509163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse