Provider Demographics
NPI:1114571387
Name:NETTER, MARQUIS
Entity Type:Individual
Prefix:
First Name:MARQUIS
Middle Name:
Last Name:NETTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 LAURISTON PL
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-1391
Mailing Address - Country:US
Mailing Address - Phone:614-301-7190
Mailing Address - Fax:
Practice Address - Street 1:281 W LANE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1132
Practice Address - Country:US
Practice Address - Phone:614-292-3980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program