Provider Demographics
NPI:1326690454
Name:MARCON-FULLER, SUZANNE LYNN
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:LYNN
Last Name:MARCON-FULLER
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 1:104A S VINE AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-3745
Mailing Address - Country:US
Mailing Address - Phone:715-651-1446
Mailing Address - Fax:
Practice Address - Street 1:204 E BLODGETT ST
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-2205
Practice Address - Country:US
Practice Address - Phone:715-207-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion