Provider Demographics
NPI:1578249231
Name:CLARK, MARQUAJAH SHAPRICE
Entity Type:Individual
Prefix:
First Name:MARQUAJAH
Middle Name:SHAPRICE
Last Name:CLARK
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 1:4001 PENNWOOD AVE APT 65
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-7526
Mailing Address - Country:US
Mailing Address - Phone:702-421-1259
Mailing Address - Fax:
Practice Address - Street 1:3300 WINTERHAVEN ST APT 225
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-5068
Practice Address - Country:US
Practice Address - Phone:702-421-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide