Provider Demographics
NPI:1366535692
Name:ALDRED, MARLENE KAY (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:KAY
Last Name:ALDRED
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 PUMPKIN LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9552
Mailing Address - Country:US
Mailing Address - Phone:260-740-2859
Mailing Address - Fax:
Practice Address - Street 1:7205 PUMPKIN LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-9552
Practice Address - Country:US
Practice Address - Phone:260-740-2859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily