MEDICARE: MRS. SATYRA KENYATTA MARS RN

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	164W00000X	Licensed Practical Nurse	PN 121884	OH
2	163W00000X	Registered Nurse	RN426011	OH

General Provider Information

NPI Number	:	1265763601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SATYRA KENYATTA MARS RN

Provider Business Mailing Address
First Line	:	3643 BURTON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1056
Country	:	US
Telephone Number	:	419-450-6623
Fax Number	:

Provider Business Practice Location Address
First Line	:	3643 BURTON AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43612-1056
Country	:	US
Telephone Number	:	419-450-6623
Fax Number	:

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

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	09/11/2018

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