Dicristina, Marlene L

Dicristina, Marlene L is an individual health care provider with primary practice located at 1230 7Th Ave , Longview WA 98632-3166. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Dicristina, Marlene L can be contacted via phone (360) 636-2400.

Contact Information

Primary practice address
1230 7Th Ave Longview WA 98632-3166
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD00047921 Washington

Profile Details

NPI number 1558368597
LBN Legal business name Dicristina, Marlene L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2005
Last updated Jan 31st, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558368597 NPPES
Iowa MEDICAID 0440388

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