Healthcare Provider Details

I. General information

NPI: 1730672262
Provider Name (Legal Business Name): KELLIE MARQUIS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2018
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 W INA RD
TUCSON AZ
85704-1985
US

IV. Provider business mailing address

3709 N CAMPBELL AVE STE 201
TUCSON AZ
85719-1563
US

V. Phone/Fax

Practice location:
  • Phone: 520-838-3540
  • Fax: 520-325-3526
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11337
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: