Provider Demographics
NPI:1114130168
Name:MARCHUK, ROSYNILL
Entity Type:Individual
Prefix:
First Name:ROSYNILL
Middle Name:
Last Name:MARCHUK
Suffix:
Gender:F
Credentials:
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 343
Mailing Address - Street 2:
Mailing Address - City:DELTA JUNCTION
Mailing Address - State:AK
Mailing Address - Zip Code:99737-0343
Mailing Address - Country:US
Mailing Address - Phone:907-895-4011
Mailing Address - Fax:907-895-4143
Practice Address - Street 1:2415 RAPIDS ST.
Practice Address - Street 2:
Practice Address - City:DELTA JUNCTION
Practice Address - State:AK
Practice Address - Zip Code:99737-1009
Practice Address - Country:US
Practice Address - Phone:907-895-4104
Practice Address - Fax:907-895-4143
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM3228Medicaid