Provider Demographics
NPI:1699722421
Name:MOUGHRABI, MARWAN M (NP-C)
Entity type:Individual
Prefix:
First Name:MARWAN
Middle Name:M
Last Name:MOUGHRABI
Suffix:
Gender:M
Credentials:NP-C
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 22696
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37422-2696
Mailing Address - Country:US
Mailing Address - Phone:423-870-1662
Mailing Address - Fax:423-877-4845
Practice Address - Street 1:5000 ALPHA LN
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4054
Practice Address - Country:US
Practice Address - Phone:423-870-1662
Practice Address - Fax:423-877-4845
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000006183363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00073120OtherRAILROAD MEDICARE
TN3901829Medicaid
TN4030309OtherBCBS-TN
TNS77853Medicare UPIN
TN3901829Medicaid
GA202I505003Medicare PIN