Provider Demographics
NPI:1215471503
Name:MARVIN, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MARVIN
Suffix:
Gender:F
Credentials:
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 2294
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-2294
Mailing Address - Country:US
Mailing Address - Phone:907-299-2765
Mailing Address - Fax:907-567-3880
Practice Address - Street 1:43961 KALIFORNSKI BEACH RD
Practice Address - Street 2:SUITE C
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8276
Practice Address - Country:US
Practice Address - Phone:907-299-2765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator