Provider Demographics
NPI:1891927588
Name:DEHAVEN, MARCIA L (RN)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:DEHAVEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:SALYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN/LPN
Mailing Address - Street 1:4322 ARCADIA BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45420-3117
Mailing Address - Country:US
Mailing Address - Phone:937-380-3805
Mailing Address - Fax:
Practice Address - Street 1:4322 ARCADIA BLVD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-3117
Practice Address - Country:US
Practice Address - Phone:937-380-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-14
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.355990163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse