Provider Demographics
NPI:1942857677
Name:MARR, TERRY LEA
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEA
Last Name:MARR
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 1:3488 2300 RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-2204
Mailing Address - Country:US
Mailing Address - Phone:620-692-3214
Mailing Address - Fax:
Practice Address - Street 1:3488 2300 RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-2204
Practice Address - Country:US
Practice Address - Phone:620-692-3214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider