Healthcare Provider Details

I. General information

NPI: 1922587989
Provider Name (Legal Business Name): MARILYN CARROLL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2018
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15477 VENTURA BLVD STE 101
SHERMAN OAKS CA
91403-3047
US

IV. Provider business mailing address

4704 WHITESBURG DR SW STE 201
HUNTSVILLE AL
35802-1681
US

V. Phone/Fax

Practice location:
  • Phone: 760-835-4213
  • Fax:
Mailing address:
  • Phone: 256-213-1800
  • Fax: 256-429-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-073969
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95037253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: