Provider Demographics
NPI:1073000709
Name:STUDEBAKER, MARCELLA EVELYN
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:EVELYN
Last Name:STUDEBAKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MASON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-4483
Mailing Address - Country:US
Mailing Address - Phone:707-463-3300
Mailing Address - Fax:
Practice Address - Street 1:169 MASON ST
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-4482
Practice Address - Country:US
Practice Address - Phone:707-463-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373H00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831522333OtherMEDI CAL