Provider Demographics
NPI:1821502741
Name:MARKS, NATHAN VAUGHAN (BA)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:VAUGHAN
Last Name:MARKS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W MAUMEE ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1901
Mailing Address - Country:US
Mailing Address - Phone:517-266-8880
Mailing Address - Fax:
Practice Address - Street 1:805 W MAUMEE ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1901
Practice Address - Country:US
Practice Address - Phone:517-266-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator