Provider Demographics
NPI:1114669918
Name:HOPPER, MARCIE (STUDENT)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:
Last Name:HOPPER
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E FOURTH PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3713
Mailing Address - Country:US
Mailing Address - Phone:360-397-8246
Mailing Address - Fax:360-469-1720
Practice Address - Street 1:5197 NW LOWER RIVER ROAD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-9866
Practice Address - Country:US
Practice Address - Phone:360-205-1222
Practice Address - Fax:360-469-1720
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program