Provider Demographics
NPI:1467687780
Name:MARKS, TIMOTHY P (LPN)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:MARKS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 VAN ANDEN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2414
Mailing Address - Country:US
Mailing Address - Phone:315-569-8409
Mailing Address - Fax:
Practice Address - Street 1:115 VAN ANDEN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2414
Practice Address - Country:US
Practice Address - Phone:315-569-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-17
Last Update Date:2009-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10-277627164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse