Provider Demographics
NPI:1346387073
Name:FROST, MARLENE ELAINE (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:ELAINE
Last Name:FROST
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 16TH STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:714-337-6852
Mailing Address - Fax:310-319-4865
Practice Address - Street 1:1245 16TH STREET
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:714-337-6852
Practice Address - Fax:424-259-6851
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP12761363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care