Provider Demographics
NPI:1033148028
Name:MARYAN, BARBARA A (ANP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:A
Last Name:MARYAN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W. NORTHERN LIGHTS BLVD
Mailing Address - Street 2:SUITE #638
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-562-3345
Mailing Address - Fax:907-562-9681
Practice Address - Street 1:3501 DENALI ST STE 203
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4039
Practice Address - Country:US
Practice Address - Phone:907-562-3345
Practice Address - Fax:907-562-9681
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKLMFTLIC#33106H00000X
AKANPLIC#170363LP0808X
AK170363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
K162423Medicare PIN