Provider Demographics
NPI:1700672383
Name:POULSEN, MARSHA MOLLY (RN)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:MOLLY
Last Name:POULSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARSHA
Other - Middle Name:MOLLY
Other - Last Name:POULSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:8024 NORMANSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-5913
Mailing Address - Country:US
Mailing Address - Phone:907-744-0416
Mailing Address - Fax:
Practice Address - Street 1:670 W FIREWEED LN STE 160
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2561
Practice Address - Country:US
Practice Address - Phone:907-770-0862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK162182163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse