Basic Information
| Provider Information | |||||||||
| NPI: | 1497869085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEGAN | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | ARNP, FNP-BC, OTRL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21401 72ND AVE W | ||||||||
| Address2: | |||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257742636 | ||||||||
| FaxNumber: | 4257742688 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 SW EVERETT MALL WAY STE G | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982042715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253555222 | ||||||||
| FaxNumber: | 4253555231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 12/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00119576 | WA | N | Nursing Service Providers | Registered Nurse | 225X00000X | OT00000745 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 363L00000X | IP60167718 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | AB37601 | 01 | WA | MEDICRE ID NUMBER | OTHER |