Provider Demographics
NPI:1447489653
Name:MARRIOTT, ELIZABETH ANN (EDIS)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANN
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:EDIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LYSTER ARMY HEALTH CLINIC
Mailing Address - Street 2:BLDG. 301 ANDREW AVE.
Mailing Address - City:FT. RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7237
Mailing Address - Fax:
Practice Address - Street 1:LYSTER ARMY HEALTH CLINIC
Practice Address - Street 2:BLDG. 301 ANDREW AVE.
Practice Address - City:FT. RUCKER
Practice Address - State:AL
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist