Individual
MARCISTA NORTHERN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2670 PRESCOTT DR, MISHAWAKA, IN 46544-6157
(817) 936-1542
Mailing address
2670 PRESCOTT DR, MISHAWAKA, IN 46544-6157
(817) 936-1542
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
92-1084197
—
IN
Enumeration date
11/18/2022
Last updated
11/18/2022
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