Provider Demographics
NPI:1932470036
Name:RALSTON, MARILYN (RN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:RALSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC65 BOX 34303
Mailing Address - Street 2:
Mailing Address - City:CONCHO
Mailing Address - State:AZ
Mailing Address - Zip Code:85924
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC65 #34303
Practice Address - Street 2:
Practice Address - City:CONCHO
Practice Address - State:AZ
Practice Address - Zip Code:85924
Practice Address - Country:US
Practice Address - Phone:928-289-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ038766163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse