Healthcare Provider Details

I. General information

NPI: 1952790750
Provider Name (Legal Business Name): MARLENE MICHELLE EDIOR-GARCIA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SW GOODYEAR BLVD
LAWTON OK
73505-9755
US

IV. Provider business mailing address

PO BOX 785
LAWTON OK
73502-0785
US

V. Phone/Fax

Practice location:
  • Phone: 580-531-5878
  • Fax: 580-531-5779
Mailing address:
  • Phone: 580-357-9984
  • Fax: 580-357-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9285701
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number118271
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: