Provider Demographics
NPI:1053603324
Name:MARCUM, KALI YVONNE ELENE (LPN)
Entity type:Individual
Prefix:MRS
First Name:KALI
Middle Name:YVONNE ELENE
Last Name:MARCUM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18243 MARCUM LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:IN
Mailing Address - Zip Code:47024-8304
Mailing Address - Country:US
Mailing Address - Phone:513-504-2517
Mailing Address - Fax:
Practice Address - Street 1:18243 MARCUM LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:IN
Practice Address - Zip Code:47024
Practice Address - Country:US
Practice Address - Phone:513-504-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 129267164W00000X
IN27063400A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0180198824OtherDRIVERS LICENSURE
OHPN 129267OtherOHIO NURSING LICENSURE
27063400AOtherINDIANA NURSING LICENSURE