MEDICARE: MRS. MARIE YOLETTE CIUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C20085967890	OTHER	FL	DRIVER LICENSE

General Provider Information

NPI Number	:	1053080317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIE YOLETTE CIUS

Provider Business Mailing Address
First Line	:	970 SE BAYFRONT AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-3912
Country	:	US
Telephone Number	:	772-940-4679
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 SE BAYFRONT AVE
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-3912
Country	:	US
Telephone Number	:	772-940-4679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2021
Last Update Date	:	09/09/2021

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