Provider Demographics
NPI:1285222828
Name:AUERNHEIMER, MARILYN L
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:L
Last Name:AUERNHEIMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 GARDINER RD UNIT 126
Mailing Address - Street 2:
Mailing Address - City:WEST KINGSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02892-1092
Mailing Address - Country:US
Mailing Address - Phone:316-772-7385
Mailing Address - Fax:
Practice Address - Street 1:169 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4330
Practice Address - Country:US
Practice Address - Phone:401-765-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN58406163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse