Provider Demographics
NPI:1306159736
Name:MARR, TERRIKA RENEA (LPN)
Entity type:Individual
Prefix:MISS
First Name:TERRIKA
Middle Name:RENEA
Last Name:MARR
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 TRUXTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-5438
Mailing Address - Country:US
Mailing Address - Phone:419-514-5386
Mailing Address - Fax:
Practice Address - Street 1:4334 TRUXTON PLACE DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-5438
Practice Address - Country:US
Practice Address - Phone:419-514-5386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH140002164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH140002OtherOHIO BOARD OF NURSING