Provider Demographics
NPI:1669412664
Name:DEAN, MARSHA (FNP)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:FNP
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 2757
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38088-2757
Mailing Address - Country:US
Mailing Address - Phone:901-755-5300
Mailing Address - Fax:901-753-9659
Practice Address - Street 1:7600 WOLF RIVER BLVD
Practice Address - Street 2:SUITE 220
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1785
Practice Address - Country:US
Practice Address - Phone:901-755-5300
Practice Address - Fax:901-756-0196
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN5796363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4068752OtherBLUE CROSS
MS02084773Medicaid
MS02084773Medicaid
TN3903149Medicare PIN