MEDICARE: VICKIE MARSH RN

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
1	163W00000X	Registered Nurse	105205	CO

General Provider Information

NPI Number	:	1326219015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICKIE MARSH RN

Provider Business Mailing Address
First Line	:	510 29 1/2 RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-5383
Country	:	US
Telephone Number	:	970-683-6616
Fax Number	:	970-254-4118

Provider Business Practice Location Address
First Line	:	510 29 1/2 RD
Second Line	:
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81504-5383
Country	:	US
Telephone Number	:	970-683-6616
Fax Number	:	970-254-4118

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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