Provider Demographics
NPI:1841287976
Name:DERKSEN, MARILYN CARTER (CNM)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:CARTER
Last Name:DERKSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:PO BOX 34876
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1876
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4096
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:STE 440
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-656-5321
Practice Address - Fax:425-656-5319
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAAP60217818367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife