Provider Demographics
NPI:1972707255
Name:SAMPLE-ORMES, MARLA ELAINE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:ELAINE
Last Name:SAMPLE-ORMES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:ELAINE
Other - Last Name:SAMPLE FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2940 W WANDER RD
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-6903
Mailing Address - Country:US
Mailing Address - Phone:623-465-8647
Mailing Address - Fax:623-465-8647
Practice Address - Street 1:2940 W WANDER RD
Practice Address - Street 2:
Practice Address - City:NEW RIVER
Practice Address - State:AZ
Practice Address - Zip Code:85087-6903
Practice Address - Country:US
Practice Address - Phone:623-221-4409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002445363LF0000X
AZRN095303 AP570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily