Provider Demographics
NPI:1912471624
Name:WITTENSOLDNER, MARINA LYNN (CNP)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:LYNN
Last Name:WITTENSOLDNER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MISS
Other - First Name:MARINA
Other - Middle Name:LYNN
Other - Last Name:VERBOSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1007 27TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1708
Mailing Address - Country:US
Mailing Address - Phone:330-501-8107
Mailing Address - Fax:
Practice Address - Street 1:830 AMHERST RD NE STE 201
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8518
Practice Address - Country:US
Practice Address - Phone:330-834-4725
Practice Address - Fax:330-834-4726
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH024093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine