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NPI Code Detail

MEDICARE: ERICA GAIL MARRIOTT FNP-C

MEDICARE: ERICA GAIL MARRIOTT FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse2003015908MO
2363LF0000XFamily Nurse Practitioner2017035199MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12003015908OTHERMOMISSOURI STATE BOARD OF NURSING REGISTERED NURSE
2F09171097OTHERAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICAN BOARD FAMILY NURSE PRACTITION

General Provider Information

NPI Number : 1104345842
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA GAIL MARRIOTT FNP-C
Provider Business Mailing Address
First Line : 1202 E MAIN ST
Second Line :
City : WILLOW SPRINGS
State : MO
Zip : 65793-3588
Country : US
Telephone Number : 417-469-1820
Fax Number :
Provider Business Practice Location Address
First Line : 1202 E MAIN ST
Second Line :
City : WILLOW SPRINGS
State : MO
Zip : 65793-3588
Country : US
Telephone Number : 417-469-1820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2017
Last Update Date : 07/21/2022

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