Provider Demographics
NPI:1871992123
Name:KLINE, MARCUS J SR (STNA)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:J
Last Name:KLINE
Suffix:SR
Gender:M
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:MAPLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44137-1431
Mailing Address - Country:US
Mailing Address - Phone:888-507-9816
Mailing Address - Fax:
Practice Address - Street 1:5223 THOMAS ST
Practice Address - Street 2:
Practice Address - City:MAPLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44137-1431
Practice Address - Country:US
Practice Address - Phone:888-507-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400912710509376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide