Provider Demographics
NPI:1740544741
Name:CID, MARIAN BAUTISTA (RN, ANP)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:BAUTISTA
Last Name:CID
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 HIGHWAY 95
Mailing Address - Street 2:SUITE 39
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86429
Mailing Address - Country:US
Mailing Address - Phone:928-758-1010
Mailing Address - Fax:928-758-1428
Practice Address - Street 1:3003 HIGHWAY 95
Practice Address - Street 2:SUITE 39
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86429
Practice Address - Country:US
Practice Address - Phone:928-758-1010
Practice Address - Fax:928-758-1428
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP1408363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ145525Medicaid