Provider Demographics
NPI:1679938849
Name:FRIEND, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:FRIEND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 AMES ST
Mailing Address - Street 2:
Mailing Address - City:ELK RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49629-9739
Mailing Address - Country:US
Mailing Address - Phone:231-342-5070
Mailing Address - Fax:
Practice Address - Street 1:2065 ROYAL VW
Practice Address - Street 2:
Practice Address - City:KEWADIN
Practice Address - State:MI
Practice Address - Zip Code:49648-8956
Practice Address - Country:US
Practice Address - Phone:123-134-2507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL525687225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist