Provider Demographics
NPI:1407693401
Name:BIXLER, MARLIN KEENE (LPN)
Entity type:Individual
Prefix:
First Name:MARLIN
Middle Name:KEENE
Last Name:BIXLER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MOOSIC HTS
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641-9510
Mailing Address - Country:US
Mailing Address - Phone:570-703-7493
Mailing Address - Fax:570-703-7119
Practice Address - Street 1:300 LACKAWANNA AVE STE 150
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-2001
Practice Address - Country:US
Practice Address - Phone:570-703-7493
Practice Address - Fax:570-703-7119
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CHT3984156F00000X
PAPN267643164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No156F00000XEye and Vision Services ProvidersTechnician/Technologist