Provider Demographics
NPI:1497869085
Name:DEGAN, MARILYN K (ARNP, FNP-BC, OTRL)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:K
Last Name:DEGAN
Suffix:
Gender:F
Credentials:ARNP, FNP-BC, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21401 72ND AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7702
Mailing Address - Country:US
Mailing Address - Phone:425-774-2636
Mailing Address - Fax:425-774-2688
Practice Address - Street 1:15 SW EVERETT MALL WAY STE G
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-2715
Practice Address - Country:US
Practice Address - Phone:425-355-5222
Practice Address - Fax:425-355-5231
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00119576163W00000X
WAOT00000745225X00000X
WAIP60167718363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB37601OtherMEDICRE ID NUMBER
WAP89936Medicare UPIN