Healthcare Provider Details

I. General information

NPI: 1003362088
Provider Name (Legal Business Name): MARCIA RENE KUCERA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 ROOSEVELT AVE STE 4
MOUNT VERNON WA
98273-2687
US

IV. Provider business mailing address

800 APACHE DR
MOUNT VERNON WA
98273-3752
US

V. Phone/Fax

Practice location:
  • Phone: 360-899-4086
  • Fax: 360-899-4124
Mailing address:
  • Phone: 360-941-2904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60670980
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: