Provider Demographics
NPI:1073064028
Name:MARSHALL, NANCY ANN (STUDENT)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:ANN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:BAKER
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:STUDENT
Mailing Address - Street 1:2027 WESTWIND RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4536
Mailing Address - Country:US
Mailing Address - Phone:575-888-7377
Mailing Address - Fax:
Practice Address - Street 1:2027 WESTWIND RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-4536
Practice Address - Country:US
Practice Address - Phone:575-888-7377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health