Healthcare Provider Details

I. General information

NPI: 1689602377
Provider Name (Legal Business Name): MARILYN TRUDEAU HOLMES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S 2ND ST
MOUNT VERNON WA
98273-4209
US

IV. Provider business mailing address

1100 S 2ND ST
MOUNT VERNON WA
98273-4209
US

V. Phone/Fax

Practice location:
  • Phone: 360-419-3500
  • Fax: 360-419-3515
Mailing address:
  • Phone: 360-419-3500
  • Fax: 360-419-3515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP30004170
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: