Provider Demographics
NPI:1225202468
Name:MARKS, MARJORIE LOUISE (RD)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:LOUISE
Last Name:MARKS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5642 E JUAREZ ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-5517
Mailing Address - Country:US
Mailing Address - Phone:520-312-8240
Mailing Address - Fax:
Practice Address - Street 1:5642 E JUAREZ ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-5517
Practice Address - Country:US
Practice Address - Phone:520-312-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2017-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYADA/CDR00533596133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered