Provider Demographics
NPI:1922249119
Name:MARQUIS, TRACY K (LMP)
Entity Type:Individual
Prefix:MR
First Name:TRACY
Middle Name:K
Last Name:MARQUIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 YELM HWY SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-4986
Mailing Address - Country:US
Mailing Address - Phone:360-491-4359
Mailing Address - Fax:
Practice Address - Street 1:4720 YELM HWY SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-4986
Practice Address - Country:US
Practice Address - Phone:360-491-4359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008798174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist