Provider Demographics
NPI:1790877694
Name:MARLEY, ERIN D (NP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:D
Last Name:MARLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5662 SUGAR RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-2205
Mailing Address - Country:US
Mailing Address - Phone:434-823-1953
Mailing Address - Fax:
Practice Address - Street 1:5662 SUGAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-2205
Practice Address - Country:US
Practice Address - Phone:434-823-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166727363L00000X
VA0001175487363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVB774AMedicare PIN