Provider Demographics
NPI:1952606303
Name:RANKIN, MARILYN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:RANKIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:E
Other - Last Name:MATLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4200 ALTAMONT PL
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3052
Mailing Address - Country:US
Mailing Address - Phone:301-645-2774
Mailing Address - Fax:
Practice Address - Street 1:4200 ALTAMONT PL
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3052
Practice Address - Country:US
Practice Address - Phone:301-645-2774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD218147363LF0000X
VA0024177088363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily