Doctor Name: | KATHRYN MARVIN |
NPI Number: | 1669837340 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | CNP 4314 |
Business Practice Address: | 100 Evergreen Sq Sw Pine City, MN - 550632000 |
Business Phone Number: | 3206296721 |
Business Fax Number: | |
Mailing Address: | 100 Evergreen Sq Sw, PINE CITY |
State: | MN |
Postal Code: | 550632000 |
Phone Number: | 3206296721 |
Fax Number: | |
NPI Enumeration Date: | 12/22/2015 |
NPI Last Update Date: | 12/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | CNP 4314 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |