Provider Demographics
NPI:1063706794
Name:WARQUE, MARIE J
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:J
Last Name:WARQUE
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 1:1900 TIERRA VISTA DR
Mailing Address - Street 2:# 204
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-2792
Mailing Address - Country:US
Mailing Address - Phone:702-943-8850
Mailing Address - Fax:
Practice Address - Street 1:1900 TIERRA VISTA DR
Practice Address - Street 2:# 204
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-2792
Practice Address - Country:US
Practice Address - Phone:702-943-8850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-28
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner