Marilyn Costas Borromeo-Wesner, ARNP
Individual provider Active NPI Adult Health Nurse Practitioner · Snohomish, WA
NPI 1205908498 · NPPES record last updated Feb 6, 2015
Key facts
- NPI
- 1205908498
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Health Nurse Practitioner 363LA2200X
- License
- AP30007479 (WA)
- Practice address
- 1830 Bickford Ave
Suite 211
Snohomish, WA 98290-1749 - Phone
- (360) 668-1820
- Fax
- (360) 668-1825
- NPI assigned
- Nov 14, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070118000542 | WA | Practitioner - Nurse Practitioner | 8628079597 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | AP30007479 | WA | Yes |
Addresses
Primary practice location
1830 Bickford Ave
Suite 211
Snohomish, WA 98290-1749
Mailing address
PO Box 3360
Portland, OR 97208-3360
Phone (866) 366-2983
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00653006 | Other | MEDICARE RAILROAD | |
| 9650862 | Medicaid | WA |
Other providers in Snohomish, WA
- Kyaw Thu Bo
- Katherine Boisseranc
- Cherokee Dawn Boman
- Annalise Boon
- Mary Jeanette Borgstrom
- Stacy Marie Bowker
- Jessica Aimee Bowman
- Ashley Alisa Bradshaw
- Althea Lynn Brandis
- Brian Eirik Coe, O.D., P.S., Inc
All providers in Snohomish, WA · Adult Health Nurse Practitioner in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.