Provider Demographics
NPI:1205389160
Name:PACHUILO, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PACHUILO
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 1:4742 119TH RD NW LOT 403
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:ND
Mailing Address - Zip Code:58843-9780
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5258
Practice Address - Country:US
Practice Address - Phone:701-774-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-27
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator