Doctor Name: | MARY MARQUIS |
NPI Number: | 1104244623 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SP012815 |
Business Practice Address: | 669 E Myrtle Ave Trevose, PA - 190534640 |
Business Phone Number: | 2153648412 |
Business Fax Number: | |
Mailing Address: | 2778 Patty Ln, WARRINGTON |
State: | PA |
Postal Code: | 189762077 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/01/2014 |
NPI Last Update Date: | 04/01/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LG0600X |
License Number: | SP012815 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |