Provider Demographics
NPI:1144514159
Name:MAMETIEFF, MARFA IVANOVNA
Entity type:Individual
Prefix:MRS
First Name:MARFA
Middle Name:IVANOVNA
Last Name:MAMETIEFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32758 310TH ST SE
Mailing Address - Street 2:
Mailing Address - City:FOSSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56542-9396
Mailing Address - Country:US
Mailing Address - Phone:218-280-5084
Mailing Address - Fax:
Practice Address - Street 1:224 3RD ST SW
Practice Address - Street 2:
Practice Address - City:FOSSTON
Practice Address - State:MN
Practice Address - Zip Code:56542-1609
Practice Address - Country:US
Practice Address - Phone:218-280-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care