Provider Demographics
NPI:1063860211
Name:HART, MARCIE KNOX (DNP)
Entity Type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:KNOX
Last Name:HART
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:JILL
Other - Last Name:KNOX-HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:483 N AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2808
Mailing Address - Country:US
Mailing Address - Phone:310-653-6623
Mailing Address - Fax:310-653-6451
Practice Address - Street 1:15 MDG
Practice Address - Street 2:755 SCOTT CIRCLE
Practice Address - City:JBPHH/HICKAM AFB
Practice Address - State:HI
Practice Address - Zip Code:96853-5399
Practice Address - Country:US
Practice Address - Phone:808-448-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023024363LF0000X
OHRN.347251390200000X
HIAPRN-3404363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program