Provider Demographics
NPI:1447850409
Name:MARCUM, TONYA RENEE
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:RENEE
Last Name:MARCUM
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 1:105 CUDDEN ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3501
Mailing Address - Country:US
Mailing Address - Phone:304-928-2292
Mailing Address - Fax:
Practice Address - Street 1:105 CUDDEN ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3501
Practice Address - Country:US
Practice Address - Phone:304-928-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant