Healthcare Provider Details

I. General information

NPI: 1467676163
Provider Name (Legal Business Name): MARLIES W. KORSTEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 N MILLER RD SUITE 102
SCOTTSDALE AZ
85251-3619
US

IV. Provider business mailing address

4300 N. MILLER ROAD SUITE 102
SCOTTSDALE AZ
85052
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-1952
  • Fax: 480-941-0610
Mailing address:
  • Phone: 480-941-1952
  • Fax: 480-941-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number20884
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: