Provider Demographics
NPI:1881824852
Name:DERKSEN, MARJORIE YVONNE (RN,CNS)
Entity Type:Individual
Prefix:MISS
First Name:MARJORIE
Middle Name:YVONNE
Last Name:DERKSEN
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Gender:F
Credentials:RN,CNS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3080 ACKERMAN BLVD., #100
Mailing Address - Street 2:DAYTON CHEST MEDICINE
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429
Mailing Address - Country:US
Mailing Address - Phone:937-396-1605
Mailing Address - Fax:937-396-1607
Practice Address - Street 1:3080 ACKERMAN BLVD., #100
Practice Address - Street 2:DAYTON CHEST MEDICINE
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429
Practice Address - Country:US
Practice Address - Phone:937-396-1605
Practice Address - Fax:937-396-1607
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH03233-NS364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist