Provider Demographics
NPI:1922572676
Name:HEBB, MARCILLA K
Entity Type:Individual
Prefix:MRS
First Name:MARCILLA
Middle Name:K
Last Name:HEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARCILLA
Other - Middle Name:K
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 ELEVENTH STREET
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-636-9150
Mailing Address - Fax:304-636-9157
Practice Address - Street 1:40 ELEVENTH STREET
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-636-9150
Practice Address - Fax:304-636-9157
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV80994163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse