Provider Demographics
NPI:1891797304
Name:UNDERWOOD, MARNI G (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARNI
Middle Name:G
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARNI
Other - Middle Name:G
Other - Last Name:KECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:32 WICKS LN
Mailing Address - Street 2:SVP - HEIGHTS FAMILY PRACTICE
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-3810
Mailing Address - Country:US
Mailing Address - Phone:406-237-8300
Mailing Address - Fax:406-237-8333
Practice Address - Street 1:6342 PHELAN BLVD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-6150
Practice Address - Country:US
Practice Address - Phone:281-783-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101469363L00000X
TXAP134988363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U528Medicare ID - Type Unspecified
MTM011007297Medicare PIN
P92118Medicare UPIN