Provider Demographics
NPI:1073792693
Name:MARKS, OPHELIA ANN (LPN)
Entity Type:Individual
Prefix:MS
First Name:OPHELIA
Middle Name:ANN
Last Name:MARKS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BOWEN ST APT 407
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-3549
Mailing Address - Country:US
Mailing Address - Phone:404-451-1314
Mailing Address - Fax:
Practice Address - Street 1:55 BOWEN ST APT 407
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-3549
Practice Address - Country:US
Practice Address - Phone:404-451-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2350881164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse