Provider Demographics
NPI:1447448477
Name:KING, MARJORIE ELIIZABETH (FNP/APRN)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ELIIZABETH
Last Name:KING
Suffix:
Gender:F
Credentials:FNP/APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 SEASIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4602
Mailing Address - Country:US
Mailing Address - Phone:203-693-2320
Mailing Address - Fax:
Practice Address - Street 1:256 SEASIDE AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4602
Practice Address - Country:US
Practice Address - Phone:203-693-2320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN118082363LF0000X
CT8034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ72366Medicare PIN