Healthcare Provider Details

I. General information

NPI: 1720495112
Provider Name (Legal Business Name): MARCI CHRISTINE ETHERIDGE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 SUNSET WAY STE 108
HENDERSON NV
89014-2053
US

IV. Provider business mailing address

828 E FLAMINGO RD APT 337
LAS VEGAS NV
89119-7314
US

V. Phone/Fax

Practice location:
  • Phone: 702-458-3738
  • Fax: 702-447-1939
Mailing address:
  • Phone: 615-738-0944
  • Fax: --

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN89058
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number18893
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002264
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: