MEDICARE: MARELDA M WHITMARSH ARPN, MN, RN NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP4151	AZ
2	363LF0000X	Family Nurse Practitioner	AP30006598	WA

General Provider Information

NPI Number	:	1285645390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARELDA M WHITMARSH ARPN, MN, RN NP-C

Provider Business Mailing Address
First Line	:	PO BOX 340
Second Line	:
City	:	DEER PARK
State	:	WA
Zip	:	99006-0340
Country	:	US
Telephone Number	:	509-262-9000
Fax Number	:	509-276-3034

Provider Business Practice Location Address
First Line	:	5952 BLACKSTONE WAY
Second Line	:
City	:	NINE MILE FALLS
State	:	WA
Zip	:	99026-4900
Country	:	US
Telephone Number	:	509-464-3627
Fax Number	:	509-466-9517

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	10/12/2022

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