Provider Demographics
NPI:1861243982
Name:MARX, MCKENNA (RN)
Entity type:Individual
Prefix:
First Name:MCKENNA
Middle Name:
Last Name:MARX
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6840 FOUNTAIN VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4708
Mailing Address - Country:US
Mailing Address - Phone:920-809-7171
Mailing Address - Fax:
Practice Address - Street 1:565 SPACE CENTER DR STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915-3610
Practice Address - Country:US
Practice Address - Phone:719-638-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-27
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1694101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse