Provider Demographics
NPI:1447403415
Name:WYANT, MARILYN ANNE (RN, BSN, MA)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:ANNE
Last Name:WYANT
Suffix:
Gender:F
Credentials:RN, BSN, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18717 N MILLER WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-6899
Mailing Address - Country:US
Mailing Address - Phone:520-568-5300
Mailing Address - Fax:520-568-6109
Practice Address - Street 1:45012 W HONEYCUTT AVE
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239-2842
Practice Address - Country:US
Practice Address - Phone:520-568-6100
Practice Address - Fax:520-568-6109
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN099816163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool