Healthcare Provider Details

I. General information

NPI: 1033595293
Provider Name (Legal Business Name): NATALIE MARCUS RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 LOWER HONOAPIILANI RD F404
LAHAINA HI
96761-8969
US

IV. Provider business mailing address

PO BOX 11264
LAHAINA HI
96761-6264
US

V. Phone/Fax

Practice location:
  • Phone: 949-200-0856
  • Fax:
Mailing address:
  • Phone: 949-200-0856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number783339
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number81070
License Number StateHI
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-49340
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: