Provider Demographics
NPI:1457301525
Name:MARQUART, VICKI MADDEN (FNP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:MADDEN
Last Name:MARQUART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 S VAL VISTA DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-7325
Mailing Address - Country:US
Mailing Address - Phone:480-766-8485
Mailing Address - Fax:480-689-5569
Practice Address - Street 1:4902 S VAL VISTA DR
Practice Address - Street 2:SUITE 110
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-7325
Practice Address - Country:US
Practice Address - Phone:480-766-8485
Practice Address - Fax:480-689-5569
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE38926OtherNE BCBS #
NE241147OtherMIDLANDS CHOICE #
NE38926OtherNE BCBS #