Provider Demographics
NPI:1205834520
Name:FIELDS, MARGENE DEANN (APRNBC)
Entity type:Individual
Prefix:MRS
First Name:MARGENE
Middle Name:DEANN
Last Name:FIELDS
Suffix:
Gender:F
Credentials:APRNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:N 24261 US HIGHWAY 101
Mailing Address - City:HOODSPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98548-0279
Mailing Address - Country:US
Mailing Address - Phone:360-877-0372
Mailing Address - Fax:360-877-0565
Practice Address - Street 1:24261 NORTH U.S. HIGHWAY 101
Practice Address - Street 2:
Practice Address - City:HOODSPORT
Practice Address - State:WA
Practice Address - Zip Code:98548-0279
Practice Address - Country:US
Practice Address - Phone:360-877-0372
Practice Address - Fax:360-877-0565
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP3003935363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9624214Medicaid
AB12465Medicare ID - Type Unspecified
WA9624214Medicaid