MEDICARE: JUDY ARLENE MARSYLA 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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	RN0138448	WA

General Provider Information

NPI Number	:	1407412216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY ARLENE MARSYLA RN

Provider Business Mailing Address
First Line	:	1827 SUSAN AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3325
Country	:	US
Telephone Number	:	360-425-4231
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 COMMERCE AVE STE 303
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3726
Country	:	US
Telephone Number	:	360-748-4480
Fax Number	:

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

Provider Enumeration Date	:	05/16/2019
Last Update Date	:	05/16/2019

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