Provider Demographics
NPI:1932970860
Name:DIB, MARLENA YASMINE (PA)
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:YASMINE
Last Name:DIB
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 BIG RUN RD
Mailing Address - Street 2:
Mailing Address - City:VOLGA
Mailing Address - State:WV
Mailing Address - Zip Code:26238-7501
Mailing Address - Country:US
Mailing Address - Phone:304-669-4967
Mailing Address - Fax:
Practice Address - Street 1:380 BIG RUN RD
Practice Address - Street 2:
Practice Address - City:VOLGA
Practice Address - State:WV
Practice Address - Zip Code:26238-7501
Practice Address - Country:US
Practice Address - Phone:304-669-4967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant