Provider Demographics
NPI:1609343490
Name:MARQUART, AMY SUE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:SUE
Last Name:MARQUART
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 1:17 E GENESEE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4068
Mailing Address - Country:US
Mailing Address - Phone:315-253-9795
Mailing Address - Fax:315-253-3255
Practice Address - Street 1:17 E GENESEE ST STE 1
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4068
Practice Address - Country:US
Practice Address - Phone:315-253-9795
Practice Address - Fax:315-253-3255
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232288164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse