Provider Demographics
NPI:1871202416
Name:LABOVE, MARCUS SHANE
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:SHANE
Last Name:LABOVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 INDIAN LILAC DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-7205
Mailing Address - Country:US
Mailing Address - Phone:469-767-3421
Mailing Address - Fax:
Practice Address - Street 1:1916 INDIAN LILAC DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-7205
Practice Address - Country:US
Practice Address - Phone:469-767-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-22
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker