MEDICARE: ISABELLA ANDREA MARIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2255A2300X	Athletic Trainer	2928	TN

General Provider Information

NPI Number	:	1134864580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABELLA ANDREA MARIAN

Provider Business Mailing Address
First Line	:	790 N CEDAR BLUFF RD APT 721
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-2242
Country	:	US
Telephone Number	:	540-270-9194
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 N CEDAR BLUFF RD APT 721
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-2242
Country	:	US
Telephone Number	:	540-270-9194
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2022
Last Update Date	:	11/06/2022

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Directions to “ ISABELLA ANDREA MARIAN ” Practice Location

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