Provider Demographics
NPI:1043804743
Name:KING, MARILYN LEE (DNP FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:LEE
Last Name:KING
Suffix:
Gender:F
Credentials:DNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 E VIA LINDA STE 104
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5316
Mailing Address - Country:US
Mailing Address - Phone:480-568-4599
Mailing Address - Fax:480-360-1951
Practice Address - Street 1:10245 E VIA LINDA STE 104
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5316
Practice Address - Country:US
Practice Address - Phone:480-568-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN156754163W00000X
AZRNP2623646363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse