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General NPI Number Information
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NPI Number | 1497869085
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Entity Type | Individual
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Provider Name | MARILYN K DEGAN ARNP, FNP-BC, OTRL
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Gender | Female
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 15 SW EVERETT MALL WAY STE G
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City | EVERETT
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State | WA
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Zip | 98204-2715
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Country | US
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Telephone | 425-355-5222
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Fax | 425-355-5231
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Provider Business Mailing Address
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Address Line | 21401 72ND AVE W
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City | EDMONDS
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State | WA
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Zip | 98026-7702
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Country | US
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Telephone | 425-774-2636
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Fax | 425-774-2688
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN00119576
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT00000745
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | IP60167718
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License Number State | WA
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