Provider Demographics
NPI:1720495112
Name:ETHERIDGE, MARCI CHRISTINE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARCI
Middle Name:CHRISTINE
Last Name:ETHERIDGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 E FLAMINGO RD APT 337
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7314
Mailing Address - Country:US
Mailing Address - Phone:615-738-0944
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:8 SUNSET WAY STE 108
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2053
Practice Address - Country:US
Practice Address - Phone:702-458-3738
Practice Address - Fax:702-447-1939
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN89058163WG0000X
TN18893363L00000X
NVAPRN002264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner