Provider Demographics
NPI:1982165544
Name:CONLIN-MARX, MARGUERITE
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:
Last Name:CONLIN-MARX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 NE 148TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-3627
Mailing Address - Country:US
Mailing Address - Phone:360-896-3363
Mailing Address - Fax:
Practice Address - Street 1:1403 NE 148TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-3627
Practice Address - Country:US
Practice Address - Phone:360-896-3363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00118760163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA24601Medicaid