MEDICARE: KELLIE MARQUIS DNP

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	363LF0000X	Family Nurse Practitioner	AP11337	AZ

General Provider Information

NPI Number	:	1730672262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE MARQUIS DNP

Provider Business Mailing Address
First Line	:	3709 N CAMPBELL AVE
Second Line	:	STE 201
City	:	TUCSON
State	:	AZ
Zip	:	85719-1563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 W INA RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85704-1985
Country	:	US
Telephone Number	:	520-838-3540
Fax Number	:	520-325-3526

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

Provider Enumeration Date	:	06/09/2018
Last Update Date	:	02/23/2021

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