Provider Demographics
NPI:1366768582
Name:WEBSTER, MARINA VLADIMIROVNA (RN)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:VLADIMIROVNA
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:VLADIMIROVNA
Other - Last Name:BUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6414 CABIN CROFT DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:OH
Mailing Address - Zip Code:43119-9777
Mailing Address - Country:US
Mailing Address - Phone:614-870-7339
Mailing Address - Fax:
Practice Address - Street 1:6414 CABIN CROFT DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:OH
Practice Address - Zip Code:43119-9777
Practice Address - Country:US
Practice Address - Phone:614-870-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN358307163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse