Provider Demographics
NPI:1508064643
Name:KAYE-MARQUARDT, MARION
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:KAYE-MARQUARDT
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 1:2702 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5547
Mailing Address - Country:US
Mailing Address - Phone:920-683-8887
Mailing Address - Fax:920-683-1216
Practice Address - Street 1:2702 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5547
Practice Address - Country:US
Practice Address - Phone:920-683-8887
Practice Address - Fax:920-683-1216
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9970-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist