Provider Demographics
NPI:1487113098
Name:CASON, MARQUETTA DENISE
Entity type:Individual
Prefix:
First Name:MARQUETTA
Middle Name:DENISE
Last Name:CASON
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 1:406 SPRING MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-3742
Mailing Address - Country:US
Mailing Address - Phone:864-757-4797
Mailing Address - Fax:
Practice Address - Street 1:406 SPRING MEADOW RD
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-3742
Practice Address - Country:US
Practice Address - Phone:864-757-4797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-14
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker