Provider Demographics
NPI:1457508418
Name:MARVIN, CHRISTY EARLEAN (CNA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:EARLEAN
Last Name:MARVIN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEISER
Mailing Address - State:ID
Mailing Address - Zip Code:83672
Mailing Address - Country:US
Mailing Address - Phone:208-861-1074
Mailing Address - Fax:
Practice Address - Street 1:1111 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEISER
Practice Address - State:ID
Practice Address - Zip Code:83672
Practice Address - Country:US
Practice Address - Phone:208-861-1074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID00016921203374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide