Provider Demographics
NPI:1134719693
Name:MARCIANA GROUP
Entity type:Organization
Organization Name:MARCIANA GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CNO
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANTINE
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:586-219-0181
Mailing Address - Street 1:2136 FORD PKWY STE 5000
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-1863
Mailing Address - Country:US
Mailing Address - Phone:651-505-6807
Mailing Address - Fax:
Practice Address - Street 1:16759 DIAMONTE PATH
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-6154
Practice Address - Country:US
Practice Address - Phone:651-398-4968
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2022-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty