Provider Demographics
NPI:1235796152
Name:MARSH, LAURIE ANN
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:MARSH
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 1:5710 CONSEAR RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49267-9772
Mailing Address - Country:US
Mailing Address - Phone:419-345-5581
Mailing Address - Fax:
Practice Address - Street 1:5710 CONSEAR RD
Practice Address - Street 2:
Practice Address - City:OTTAWA LAKE
Practice Address - State:MI
Practice Address - Zip Code:49267-9772
Practice Address - Country:US
Practice Address - Phone:419-345-5581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH052462164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse