Provider Demographics
NPI:1366873887
Name:MARVIN, CRAIG F (APRN)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:F
Last Name:MARVIN
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 775641
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-543-6979
Mailing Address - Fax:
Practice Address - Street 1:4962 ELM SPRINGS RD STE 5
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-3712
Practice Address - Country:US
Practice Address - Phone:479-318-0161
Practice Address - Fax:479-318-0162
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily