Provider Demographics
NPI:1689091118
Name:FARIAS, MARGIE (NCTMB, CST)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:
Last Name:FARIAS
Suffix:
Gender:F
Credentials:NCTMB, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3224
Mailing Address - Country:US
Mailing Address - Phone:307-332-9457
Mailing Address - Fax:
Practice Address - Street 1:532 S 8TH ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3224
Practice Address - Country:US
Practice Address - Phone:307-332-9457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist