Provider Demographics
NPI:1720012867
Name:TRABER, MARCIA LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LYNN
Last Name:TRABER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARICA
Other - Middle Name:LYNN
Other - Last Name:AMSTUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:1214 RIDGEWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402
Mailing Address - Country:US
Mailing Address - Phone:419-352-8427
Mailing Address - Fax:419-352-2120
Practice Address - Street 1:1214 RIDGEWOOD DR.
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402
Practice Address - Country:US
Practice Address - Phone:419-352-8427
Practice Address - Fax:419-352-2120
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN131595363LA2200X
OHNP01160363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2034462Medicaid
OH2034462Medicaid