Provider Demographics
NPI:1851901144
Name:PROCTOR, MARILYN R
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:R
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 40TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-1031
Mailing Address - Country:US
Mailing Address - Phone:202-847-8862
Mailing Address - Fax:
Practice Address - Street 1:1301 7TH ST NW APT 222
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-3515
Practice Address - Country:US
Practice Address - Phone:202-253-2717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant