Healthcare Provider Details

I. General information

NPI: 1629329511
Provider Name (Legal Business Name): MARLEN PUTMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SOLAREX CT
FREDERICK MD
21703-8624
US

IV. Provider business mailing address

610 SOLAREX CT
FREDERICK MD
21703-8624
US

V. Phone/Fax

Practice location:
  • Phone: 240-457-3244
  • Fax: 301-662-1873
Mailing address:
  • Phone: 240-457-3244
  • Fax: 301-662-1873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR118796
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: