Provider Demographics
NPI:1770834004
Name:MARDEN, ROBERT WESLEY
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:WESLEY
Last Name:MARDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 RIDGEPARK RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-4739
Mailing Address - Country:US
Mailing Address - Phone:866-308-9925
Mailing Address - Fax:
Practice Address - Street 1:4081 HIGHWAY 7 S
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-5047
Practice Address - Country:US
Practice Address - Phone:866-308-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator