Provider Demographics
NPI:1598334781
Name:PATHAN, MARINA (ARNP)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PATHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13435 UNIVERSITY AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8251
Mailing Address - Country:US
Mailing Address - Phone:515-225-7132
Mailing Address - Fax:
Practice Address - Street 1:13435 UNIVERSITY AVE STE 500
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8251
Practice Address - Country:US
Practice Address - Phone:515-225-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA162929363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner