Individual
MARLENE A BEVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
872 MUNSON AVE STE D, TRAVERSE CITY, MI 49686-3638
(231) 238-3111
(231) 238-3214
Mailing address
872 MUNSON AVE, STE D, TRAVERSE CITY, MI 49686-3638
(231) 938-3111
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
—
MI
237600000X
Audiologist-Hearing Aid Fitter
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
540B802900
BLUE CROSS BLUE SHIELD
MI
01
—
640B827240
BLUE CROSS BLUE SHIELD
MI
05
—
804707447
—
MI
05
—
804707456
—
MI
05
—
804707465
—
MI
05
—
902575198
—
MI
05
—
903380558
—
MI
Enumeration date
06/18/2006
Last updated
12/17/2019
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