Provider Demographics
NPI:1013021807
Name:KIRBY, MARLO ARVILLA (MSN, NP)
Entity Type:Individual
Prefix:MRS
First Name:MARLO
Middle Name:ARVILLA
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:MRS
Other - First Name:MARLO
Other - Middle Name:ARVILLA
Other - Last Name:GAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:200 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1143
Mailing Address - Country:US
Mailing Address - Phone:269-781-4271
Mailing Address - Fax:
Practice Address - Street 1:200 N MADISON ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1143
Practice Address - Country:US
Practice Address - Phone:269-781-4271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704216807363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4790130Medicaid
MIQ56230Medicare UPIN