Provider Demographics
NPI:1972701704
Name:BURMARK, MARILYN J (ARNP)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:BURMARK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:J
Other - Last Name:DROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 S J ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4933
Mailing Address - Country:US
Mailing Address - Phone:253-426-6893
Mailing Address - Fax:253-426-6449
Practice Address - Street 1:1717 S J ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4933
Practice Address - Country:US
Practice Address - Phone:253-426-6893
Practice Address - Fax:253-426-6449
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004615363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8940836OtherSTATE CRIME VICTIMS
WA9626813Medicaid
WA0206372OtherSTATE L&I
WA8940836OtherSTATE CRIME VICTIMS
WA8858814Medicare ID - Type Unspecified
WAG8853724Medicare PIN