Provider Demographics
NPI:1346661758
Name:CURTIS, MARILYN (MED)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 REZANOF DR E
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6416
Mailing Address - Country:US
Mailing Address - Phone:907-481-2400
Mailing Address - Fax:907-481-2419
Practice Address - Street 1:717 REZANOF DR E
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6416
Practice Address - Country:US
Practice Address - Phone:907-481-2400
Practice Address - Fax:907-481-2419
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1021028Medicaid