Healthcare Provider Details

I. General information

NPI: 1053600684
Provider Name (Legal Business Name): MARILYN DANSESREAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 C ST
HAWTHORNE NV
89415-0012
US

IV. Provider business mailing address

1665 OLD HOT SPRINGS RD SUITE 157
CARSON CITY NV
89706-0782
US

V. Phone/Fax

Practice location:
  • Phone: 775-945-3368
  • Fax: 775-945-2307
Mailing address:
  • Phone: 775-687-5162
  • Fax: 775-687-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberTRN 330120
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: