Provider Demographics
NPI:1376389411
Name:DIVERS, MARNIE A (RN)
Entity type:Individual
Prefix:
First Name:MARNIE
Middle Name:A
Last Name:DIVERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 SATINWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST MIFFLIN
Mailing Address - State:PA
Mailing Address - Zip Code:15122-1244
Mailing Address - Country:US
Mailing Address - Phone:412-478-4185
Mailing Address - Fax:
Practice Address - Street 1:491 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1901
Practice Address - Country:US
Practice Address - Phone:866-419-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN501281L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse