Healthcare Provider Details

I. General information

NPI: 1417415183
Provider Name (Legal Business Name): MARIE EKREN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21139 S 187TH WAY
QUEEN CREEK AZ
85142-3584
US

IV. Provider business mailing address

42068 N RATTLESNAKE RD
SAN TAN VALLEY AZ
85140-8858
US

V. Phone/Fax

Practice location:
  • Phone: 602-345-0348
  • Fax: 602-848-8890
Mailing address:
  • Phone: 602-345-0348
  • Fax: 602-848-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN138316
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRNP246860
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: