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General NPI Number Information
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NPI Number | 1598942963
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Entity Type | Individual
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Provider Name | MARNIE VANSTRUM MD
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Gender | Female
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Dates
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Enumeration Date | 01/28/2008
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 1410 WILSON RD
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City | NEWBERRY
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State | SC
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Zip | 29108-3050
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Country | US
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Telephone | 803-276-2186
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Fax |
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Provider Business Mailing Address
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Address Line | 4418 COMMONS DR E BAY C
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City | DESTIN
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State | FL
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Zip | 32541-8405
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Country | US
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Telephone | 850-650-3148
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Fax | 850-650-3895
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME100572
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME100572
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License Number State | FL
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