Provider Demographics
NPI:1578649679
Name:MARCKMANN, CYDNE J (ARNP)
Entity Type:Individual
Prefix:
First Name:CYDNE
Middle Name:J
Last Name:MARCKMANN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2188
Mailing Address - Country:US
Mailing Address - Phone:253-848-5951
Mailing Address - Fax:253-864-8954
Practice Address - Street 1:3908 10TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2188
Practice Address - Country:US
Practice Address - Phone:253-848-5951
Practice Address - Fax:253-864-8954
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP00005497363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9628025Medicaid
WA7801151OtherAETNA PROVIDER ID
WAP00120589OtherMEDICARE RAILROAD
WA0170567OtherL&I
WA8934626OtherL&I CVC
WA9838MAOtherREGENCE RIDER
WAP00120589OtherMEDICARE RAILROAD
WA9838MAOtherREGENCE RIDER