Provider Demographics
NPI:1265763601
Name:MARS, SATYRA KENYATTA (RN)
Entity type:Individual
Prefix:MRS
First Name:SATYRA
Middle Name:KENYATTA
Last Name:MARS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:SATYRA
Other - Middle Name:K
Other - Last Name:HODRICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3643 BURTON AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43612-1056
Mailing Address - Country:US
Mailing Address - Phone:419-450-6623
Mailing Address - Fax:
Practice Address - Street 1:3643 BURTON AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43612-1056
Practice Address - Country:US
Practice Address - Phone:419-450-6623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 121884164W00000X
OHRN426011163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse