Provider Demographics
NPI:1891228854
Name:MARKS, SUSAN (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 KEEHNER AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-3312
Mailing Address - Country:US
Mailing Address - Phone:608-577-5778
Mailing Address - Fax:
Practice Address - Street 1:2890 GATEWAY OAKS DR
Practice Address - Street 2:SUITE 250
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-4326
Practice Address - Country:US
Practice Address - Phone:608-577-5778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA427292163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse