Individual
MS. MARNIE VANSTRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1410 WILSON RD, NEWBERRY, SC 29108-3050
(803) 276-2186
Mailing address
4418 COMMONS DR E, BAY C, DESTIN, FL 32541-8405
(850) 650-3148
(850) 650-3895
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME100572
FL
207R00000X
Internal Medicine Physician
ME100572
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
281205300
—
FL
01
—
ME100572
FL STATE LICENSE
FL
Enumeration date
01/28/2008
Last updated
01/30/2019
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