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General NPI Number Information
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NPI Number | 1679938849
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Entity Type | Individual
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Provider Name | MARINA FRIEND
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Gender | Female
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 2065 ROYAL VW
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City | KEWADIN
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State | MI
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Zip | 49648-8956
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Country | US
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Telephone | 123-134-2507
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Fax |
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Provider Business Mailing Address
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Address Line | 128 AMES ST
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City | ELK RAPIDS
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State | MI
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Zip | 49629-9739
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Country | US
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Telephone | 231-342-5070
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Fax |
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | L525687
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License Number State | MI
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