Healthcare Provider Details

I. General information

NPI: 1568326767
Provider Name (Legal Business Name): MARLYCE ELIZABETH MCKINNON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 DELUCCHI LN
RENO NV
89502-6578
US

IV. Provider business mailing address

1575 DELUCCHI LN STE 214
RENO NV
89502-8521
US

V. Phone/Fax

Practice location:
  • Phone: 775-827-2298
  • Fax: 775-824-3860
Mailing address:
  • Phone: 775-827-2298
  • Fax: 775-824-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number810621
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: