Provider Demographics
NPI:1285178228
Name:MARKS, MARYANN (NC)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:NC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8545 COPPERTOWNE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-8060
Mailing Address - Country:US
Mailing Address - Phone:847-668-1934
Mailing Address - Fax:
Practice Address - Street 1:8545 COPPERTOWNE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-8060
Practice Address - Country:US
Practice Address - Phone:847-668-1934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education