Provider Demographics
NPI:1912315029
Name:MARCUS, DAISY CRYSTAL MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:CRYSTAL MARIE
Last Name:MARCUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:DAISY
Other - Middle Name:CRYSTAL MARIE
Other - Last Name:RYSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2672 TWO RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-7821
Mailing Address - Country:US
Mailing Address - Phone:740-409-2449
Mailing Address - Fax:
Practice Address - Street 1:2672 TWO RIDGE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-7821
Practice Address - Country:US
Practice Address - Phone:740-409-2449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK151818164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse