Provider Demographics
NPI:1003889692
Name:MARSHALL, JUDITH M (APN)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W FULLERTON AVE
Mailing Address - Street 2:BOX 21
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2427
Mailing Address - Country:US
Mailing Address - Phone:773-880-4553
Mailing Address - Fax:
Practice Address - Street 1:900 W FULLERTON AVE
Practice Address - Street 2:BOX 21
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2427
Practice Address - Country:US
Practice Address - Phone:773-880-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily