Basic Information
| Provider Information | |||||||||
| NPI: | 1851757314 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKS | ||||||||
| FirstName: | MEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 724 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LA CROSSE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546014121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087843083 | ||||||||
| FaxNumber: | 6087844245 | ||||||||
| Practice Location | |||||||||
| Address1: | 724 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LA CROSSE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 546014121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6087843083 | ||||||||
| FaxNumber: | 6087844245 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2016 | ||||||||
| LastUpdateDate: | 01/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 196043-03 | WI | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.