Provider Demographics
NPI:1316939283
Name:MARCUM, BRENDA K (CRNA)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:MARCUM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:HORNER
Mailing Address - State:WV
Mailing Address - Zip Code:26372-0189
Mailing Address - Country:US
Mailing Address - Phone:304-269-0878
Mailing Address - Fax:304-269-8090
Practice Address - Street 1:230 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-8558
Practice Address - Country:US
Practice Address - Phone:304-269-8090
Practice Address - Fax:304-269-8090
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000076353367500000X
WV22816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3605228Medicaid
TN3605228Medicaid