Provider Demographics
NPI:1699074930
Name:FORTIN, MARILYN EVELYN (REG NURSE)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:EVELYN
Last Name:FORTIN
Suffix:
Gender:F
Credentials:REG NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 CONSTITUTION BLVD BLDG 400
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3100
Mailing Address - Country:US
Mailing Address - Phone:831-796-1700
Mailing Address - Fax:831-769-0552
Practice Address - Street 1:1441 CONSTITUTION BLVD BLDG 400
Practice Address - Street 2:SUITE 202
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3100
Practice Address - Country:US
Practice Address - Phone:831-796-1700
Practice Address - Fax:831-769-0552
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68971163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse