Provider Demographics
NPI:1669954475
Name:MARIN, ERIKA VANELLE (PA-C)
Entity type:Individual
Prefix:
First Name:ERIKA
Middle Name:VANELLE
Last Name:MARIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 RALEIGH CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46725-7422
Mailing Address - Country:US
Mailing Address - Phone:605-941-0641
Mailing Address - Fax:
Practice Address - Street 1:2680 ESCALADE WAY
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582
Practice Address - Country:US
Practice Address - Phone:574-306-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical