Provider Demographics
NPI:1003331570
Name:STOTT, MARIAN MADOLYN (RN)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:MADOLYN
Last Name:STOTT
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 1:6084 APPLE TREE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-0305
Mailing Address - Country:US
Mailing Address - Phone:901-207-4804
Mailing Address - Fax:901-255-0758
Practice Address - Street 1:6084 APPLE TREE DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-0305
Practice Address - Country:US
Practice Address - Phone:901-207-4804
Practice Address - Fax:901-255-0758
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN112425163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse