Provider Demographics
NPI:1114013612
Name:CRIDDLE, MARILYN (ARNP, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:CRIDDLE
Suffix:
Gender:F
Credentials:ARNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 UNIVERSITY ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2507
Mailing Address - Country:US
Mailing Address - Phone:206-624-1552
Mailing Address - Fax:206-467-0212
Practice Address - Street 1:411 UNIVERSITY ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2507
Practice Address - Country:US
Practice Address - Phone:206-624-1552
Practice Address - Fax:206-467-0212
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30000645363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB36772Medicare ID - Type Unspecified