Provider Demographics
NPI:1033162961
Name:NIVEN, MARSHA (PA)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:NIVEN
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:PO BOX 201606
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1606
Mailing Address - Country:US
Mailing Address - Phone:972-758-3598
Mailing Address - Fax:
Practice Address - Street 1:3535 S I-35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6850
Practice Address - Country:US
Practice Address - Phone:940-384-3500
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2022-06-30
Deactivation Date:2022-05-29
Deactivation Code:
Reactivation Date:2022-06-30
Provider Licenses
StateLicense IDTaxonomies
TXPA02828363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS64562Medicare UPIN
TX8G4104Medicare ID - Type Unspecified