Provider Demographics
NPI:1336276229
Name:FOREMAN, MARSHA A II (RN)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:A
Last Name:FOREMAN
Suffix:II
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 CIMARRON RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:43760-9769
Mailing Address - Country:US
Mailing Address - Phone:174-078-7260
Mailing Address - Fax:
Practice Address - Street 1:6335 CIMARRON RD
Practice Address - Street 2:
Practice Address - City:MOUNT PERRY
Practice Address - State:OH
Practice Address - Zip Code:43760-9769
Practice Address - Country:US
Practice Address - Phone:174-078-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-277163163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2665816Medicaid