Provider Demographics
NPI:1689673634
Name:MARRA, KRISTEN D (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:MARRA
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:537 STANTON CHRISTIANA RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2146
Mailing Address - Country:US
Mailing Address - Phone:302-225-2380
Mailing Address - Fax:302-225-2388
Practice Address - Street 1:537 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2146
Practice Address - Country:US
Practice Address - Phone:302-225-2380
Practice Address - Fax:302-225-2388
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC5-0000547363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1689673634Medicaid
MN0688082OtherDEA
P45123Medicare UPIN
MN0688082OtherDEA