Provider Demographics
NPI:1003512856
Name:MARSHALL, BENJAMIN OWEN (MSN, RN, CPHQ)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:OWEN
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MSN, RN, CPHQ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 B DR N
Mailing Address - Street 2:
Mailing Address - City:CERESCO
Mailing Address - State:MI
Mailing Address - Zip Code:49033-9633
Mailing Address - Country:US
Mailing Address - Phone:517-897-3705
Mailing Address - Fax:
Practice Address - Street 1:7855 CURRIER DR # D7
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-4314
Practice Address - Country:US
Practice Address - Phone:269-323-7748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704371368163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704371368OtherREGISTERED NURSE LICENSE