Provider Demographics
NPI:1831795335
Name:MARPLE, MARY LUCELLE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LUCELLE
Last Name:MARPLE
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 1:207 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SUTTON
Mailing Address - State:WV
Mailing Address - Zip Code:26601-1425
Mailing Address - Country:US
Mailing Address - Phone:304-678-5024
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:589 MIDWAY RD
Practice Address - Street 2:
Practice Address - City:ALUM CREEK
Practice Address - State:WV
Practice Address - Zip Code:25003-9577
Practice Address - Country:US
Practice Address - Phone:304-744-1636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant