Provider Demographics
NPI:1104416551
Name:LAYNE, MARIAN GAY
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:GAY
Last Name:LAYNE
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 1:36 SPENCE ST
Mailing Address - Street 2:
Mailing Address - City:DELBARTON
Mailing Address - State:WV
Mailing Address - Zip Code:25670-7275
Mailing Address - Country:US
Mailing Address - Phone:304-928-1972
Mailing Address - Fax:
Practice Address - Street 1:300 PROSPERITY LN STE 277
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3743
Practice Address - Country:US
Practice Address - Phone:304-928-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty