Provider Demographics
NPI:1477728673
Name:MARCUS, KATHLEEN RENE (RD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:RENE
Last Name:MARCUS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:RENE
Other - Last Name:ZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6845 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4928
Mailing Address - Country:US
Mailing Address - Phone:330-758-0723
Mailing Address - Fax:330-726-9855
Practice Address - Street 1:6845 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4928
Practice Address - Country:US
Practice Address - Phone:330-758-0723
Practice Address - Fax:330-726-9855
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 2332133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered