Provider Demographics
NPI:1164063988
Name:FRIAL, MARIAN EVANS
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:EVANS
Last Name:FRIAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARIAN
Other - Middle Name:CHRISTINE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 REESE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-9015
Mailing Address - Country:US
Mailing Address - Phone:719-360-9184
Mailing Address - Fax:
Practice Address - Street 1:1600 REESE DR APT 4
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-9015
Practice Address - Country:US
Practice Address - Phone:719-360-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant