Healthcare Provider Details

I. General information

NPI: 1669353884
Provider Name (Legal Business Name): MARLENE DIANE BIVINS-ISERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8948 S 45 RD
CADILLAC MI
49601-8571
US

IV. Provider business mailing address

8948 S 45 RD
CADILLAC MI
49601-8571
US

V. Phone/Fax

Practice location:
  • Phone: 208-739-8658
  • Fax:
Mailing address:
  • Phone: 208-739-8658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: