Provider Demographics
NPI:1659468494
Name:HUGHES, MARIAN SUZANNE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:SUZANNE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 4TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4201
Mailing Address - Country:US
Mailing Address - Phone:707-293-6637
Mailing Address - Fax:
Practice Address - Street 1:210 4TH ST STE C
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-4201
Practice Address - Country:US
Practice Address - Phone:707-293-6647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10159171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist