Provider Demographics
NPI:1700877644
Name:MARRA, DEBORAH L (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:MARRA
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:321 S EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-5849
Mailing Address - Country:US
Mailing Address - Phone:304-256-6500
Mailing Address - Fax:304-929-6501
Practice Address - Street 1:1802 HARPER RD
Practice Address - Street 2:STE 102
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3376
Practice Address - Country:US
Practice Address - Phone:304-252-9211
Practice Address - Fax:304-252-9218
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24494363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0166923000Medicaid
WV001714987OtherBC
WVNP00592Medicare ID - Type Unspecified
WV0166923000Medicaid