Provider Demographics
NPI:1043068554
Name:CANTERBURY, MARLEY ROSE (ACNP-AG, AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:MARLEY
Middle Name:ROSE
Last Name:CANTERBURY
Suffix:
Gender:F
Credentials:ACNP-AG, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 HOLLOW RDG
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3441
Mailing Address - Country:US
Mailing Address - Phone:615-854-3371
Mailing Address - Fax:
Practice Address - Street 1:2829 BABCOCK RD STE 106
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-6009
Practice Address - Country:US
Practice Address - Phone:210-951-9055
Practice Address - Fax:210-951-9066
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058900363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care