Provider Demographics
NPI:1326081902
Name:HORN, MARILEE K (PA)
Entity Type:Individual
Prefix:
First Name:MARILEE
Middle Name:K
Last Name:HORN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:7650 E PARHAM RD
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4373
Practice Address - Country:US
Practice Address - Phone:804-288-3136
Practice Address - Fax:804-288-4538
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-01-29
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Provider Licenses
StateLicense IDTaxonomies
VA0110001292363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA540885859OtherC&O EMPLOYEE'S HEALTHCARE
VA540885859OtherPRIVATE HEALTHCARE SYSTEM
VA0536744OtherAETNA HMO
VA59128OtherANTHEM HEALTHKEEPERS
VA008940681Medicaid
VA285577OtherSOUTHERN HEALTH
VA540885859OtherCORVEL
VA540885859OtherFOCUS
VA540885859OtherUNITED HEALTHCARE MAMSI
VA540885859OtherCOMPMANAGEMENT
VA30804OtherSH CARENET
VA0900313OtherUNITED HEALTHCARE
VA540885859OtherFIRST HEALTH/CCN
VA540885859OtherCIGNA
VA285577OtherSOUTHERN HEALTH
VA59128OtherANTHEM HEALTHKEEPERS
VA540885859OtherFIRST HEALTH/CCN