Provider Demographics
NPI:1093070880
Name:DOWNEN, MARBIE (MT)
Entity Type:Individual
Prefix:
First Name:MARBIE
Middle Name:
Last Name:DOWNEN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S WEST ST
Mailing Address - Street 2:EXECUTIVE CENTER SUITE 123
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-1334
Mailing Address - Country:US
Mailing Address - Phone:812-887-3946
Mailing Address - Fax:866-501-9318
Practice Address - Street 1:801 S WEST ST
Practice Address - Street 2:EXECUTIVE CENTER SUITE 123
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-1334
Practice Address - Country:US
Practice Address - Phone:812-887-3946
Practice Address - Fax:866-501-9318
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL143106246QM0706X, 246RM2200X, 246RP1900X, 247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician