Provider Demographics
NPI:1356997605
Name:MARUSKA, MICAH
Entity type:Individual
Prefix:
First Name:MICAH
Middle Name:
Last Name:MARUSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6306 S FAWNLAKE DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-8040
Mailing Address - Country:US
Mailing Address - Phone:713-965-3202
Mailing Address - Fax:
Practice Address - Street 1:6306 S FAWNLAKE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-8040
Practice Address - Country:US
Practice Address - Phone:713-965-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX349159164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse