1376787853 NPI number — MRS. MARY FRANCES TYSON-MARCHINO MFT, CSAC, RPT

Table of content: MRS. MARY FRANCES TYSON-MARCHINO MFT, CSAC, RPT (NPI 1376787853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376787853 NPI number — MRS. MARY FRANCES TYSON-MARCHINO MFT, CSAC, RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYSON-MARCHINO
Provider First Name:
MARY
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MFT, CSAC, RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TYSON
Provider Other First Name:
MARY
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT, CSAC, RPT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1376787853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALAHEO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96741-0339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-652-2862
Provider Business Mailing Address Fax Number:
808-320-3933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3417 POIPU RD
Provider Second Line Business Practice Location Address:
#104
Provider Business Practice Location Address City Name:
KOLOA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96756-8546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-652-2862
Provider Business Practice Location Address Fax Number:
808-320-3933
Provider Enumeration Date:
04/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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