Provider Demographics
NPI:1821680935
Name:SMITH, MARQUES TURAND
Entity Type:Individual
Prefix:
First Name:MARQUES
Middle Name:TURAND
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 N MARTIN L KING BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-7676
Mailing Address - Country:US
Mailing Address - Phone:702-636-6412
Mailing Address - Fax:702-636-6055
Practice Address - Street 1:3925 N MARTIN L KING BLVD STE 218
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7676
Practice Address - Country:US
Practice Address - Phone:702-636-6412
Practice Address - Fax:702-636-6055
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20211999833251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health