Provider Demographics
NPI:1053080317
Name:CIUS, MARIE YOLETTE
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:YOLETTE
Last Name:CIUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 SE BAYFRONT AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-3912
Mailing Address - Country:US
Mailing Address - Phone:772-940-4679
Mailing Address - Fax:
Practice Address - Street 1:970 SE BAYFRONT AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3912
Practice Address - Country:US
Practice Address - Phone:772-940-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC20085967890OtherDRIVER LICENSE