Provider Demographics
NPI:1952790750
Name:EDIOR-GARCIA, MARLENE MICHELLE (ARNP)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:MICHELLE
Last Name:EDIOR-GARCIA
Suffix:
Gender:F
Credentials:ARNP
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 785
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73502-0785
Mailing Address - Country:US
Mailing Address - Phone:580-357-9984
Mailing Address - Fax:580-357-3277
Practice Address - Street 1:901 SW GOODYEAR BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9755
Practice Address - Country:US
Practice Address - Phone:580-531-5878
Practice Address - Fax:580-531-5779
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9285701163W00000X
OK118271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse