Provider Demographics
NPI:1487674081
Name:DIRVIN, MARIE EILEEN (CRNA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:EILEEN
Last Name:DIRVIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:DIRVIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:111 S 11TH ST
Mailing Address - Street 2:SUITE 8490 GIBBON
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-6161
Mailing Address - Fax:215-923-5507
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:SUITE 8490
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6161
Practice Address - Fax:215-923-5507
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN281235L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered