Provider Demographics
NPI:1982684957
Name:PALEN, MARILYN LEE (PA-C)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:LEE
Last Name:PALEN
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:LEE
Other - Last Name:TIGGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1920 E CAMBRIDGE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1464
Mailing Address - Country:US
Mailing Address - Phone:602-933-5200
Mailing Address - Fax:
Practice Address - Street 1:1920 E CAMBRIDGE AVE STE 302
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1464
Practice Address - Country:US
Practice Address - Phone:602-933-5200
Practice Address - Fax:602-933-4272
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ453217-001Medicaid