Provider Demographics
NPI:1407151418
Name:MCDERMOTT, MARIE (MSN, NP-C)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N WILMOT RD
Mailing Address - Street 2:STE. A-110
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4416
Mailing Address - Country:US
Mailing Address - Phone:520-886-4181
Mailing Address - Fax:
Practice Address - Street 1:5555 E 5TH ST STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2415
Practice Address - Country:US
Practice Address - Phone:520-886-4181
Practice Address - Fax:520-721-7536
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP3913363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health