Provider Demographics
NPI:1912932963
Name:BATHURST, MARCIA J (MSN, CRNP, RN)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:J
Last Name:BATHURST
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Gender:F
Credentials:MSN, CRNP, RN
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Mailing Address - Street 1:881 HILLS PLZ
Mailing Address - Street 2:SUITE 530
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4213
Mailing Address - Country:US
Mailing Address - Phone:814-419-8084
Mailing Address - Fax:814-419-8053
Practice Address - Street 1:881 HILLS PLZ
Practice Address - Street 2:SUITE 530
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4213
Practice Address - Country:US
Practice Address - Phone:814-419-8084
Practice Address - Fax:814-419-8053
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PATP004838B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003592Medicare ID - Type Unspecified
PAS46820Medicare UPIN