Provider Demographics
NPI:1235128596
Name:DEAN, MARILYN P (ARNP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:P
Last Name:DEAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 N ARCADE ST
Mailing Address - Street 2:
Mailing Address - City:MAQUOKETA
Mailing Address - State:IA
Mailing Address - Zip Code:52060-2022
Mailing Address - Country:US
Mailing Address - Phone:563-652-6711
Mailing Address - Fax:563-652-6715
Practice Address - Street 1:206 N ARCADE ST
Practice Address - Street 2:
Practice Address - City:MAQUOKETA
Practice Address - State:IA
Practice Address - Zip Code:52060-2022
Practice Address - Country:US
Practice Address - Phone:563-652-6711
Practice Address - Fax:563-652-6715
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA044192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0982Medicare ID - Type Unspecified
P18248Medicare UPIN