Provider Demographics
NPI:1033595293
Name:MARCUS, NATALIE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:MARCUS
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11264
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-6264
Mailing Address - Country:US
Mailing Address - Phone:949-200-0856
Mailing Address - Fax:
Practice Address - Street 1:4242 LOWER HONOAPIILANI RD
Practice Address - Street 2:F404
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-8969
Practice Address - Country:US
Practice Address - Phone:949-200-0856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA783339163W00000X
HI81070163WL0100X
CAL-49340163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIW-40892867-01OtherTAX ID