Provider Demographics
NPI:1134864580
Name:MARIAN, ISABELLA ANDREA
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:ANDREA
Last Name:MARIAN
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 1:790 N CEDAR BLUFF RD APT 721
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2242
Mailing Address - Country:US
Mailing Address - Phone:540-270-9194
Mailing Address - Fax:
Practice Address - Street 1:790 N CEDAR BLUFF RD APT 721
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-2242
Practice Address - Country:US
Practice Address - Phone:540-270-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-30
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TN29282255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program