Provider Demographics
NPI:1346839420
Name:MEYER, MARLEY LYNN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARLEY
Middle Name:LYNN
Last Name:MEYER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40920 N HAWK RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-3918
Mailing Address - Country:US
Mailing Address - Phone:928-300-8228
Mailing Address - Fax:
Practice Address - Street 1:20172 E STAGECOACH TRL
Practice Address - Street 2:
Practice Address - City:MAYER
Practice Address - State:AZ
Practice Address - Zip Code:86333-2357
Practice Address - Country:US
Practice Address - Phone:928-632-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily