Provider Demographics
NPI:1043282353
Name:MARSHALL, JOAN R (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:R
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HEMINGWAY DR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2681
Mailing Address - Country:US
Mailing Address - Phone:203-294-4249
Mailing Address - Fax:
Practice Address - Street 1:23 HEMINGWAY DR
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2681
Practice Address - Country:US
Practice Address - Phone:203-294-4249
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE23054163W00000X
CT000496163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE23054OtherRN
CT000496OtherAPRN