Provider Demographics
NPI:1124685110
Name:DOCTOR, MARINA (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:DOCTOR
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HAUENSTEIN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-8803
Mailing Address - Country:US
Mailing Address - Phone:260-204-0505
Mailing Address - Fax:
Practice Address - Street 1:225 HAUENSTEIN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-8803
Practice Address - Country:US
Practice Address - Phone:260-204-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28227275A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28227275AOtherRN LICENSE