Provider Demographics
NPI:1639529902
Name:SCRIVNER, MARVIN DELONTAE JR
Entity Type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:DELONTAE
Last Name:SCRIVNER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5513 BALDWIN BLVD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48505-5115
Mailing Address - Country:US
Mailing Address - Phone:810-347-1677
Mailing Address - Fax:
Practice Address - Street 1:5513 BALDWIN BLVD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48505-5115
Practice Address - Country:US
Practice Address - Phone:810-347-1677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other