Provider Demographics
NPI:1346612108
Name:MARQUES, COURTNEY (RDN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MARQUES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 MARKET ST
Mailing Address - Street 2:APT. 2
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2724
Mailing Address - Country:US
Mailing Address - Phone:630-267-1883
Mailing Address - Fax:
Practice Address - Street 1:6100 SAINT LAWRENCE CTR
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-3214
Practice Address - Country:US
Practice Address - Phone:630-267-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86038897133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered