Provider Demographics
NPI:1073708145
Name:MARSHALL, CARRIE VIRGINIA (PNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:VIRGINIA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BEACON ST
Mailing Address - Street 2:APT. 7A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2804
Mailing Address - Country:US
Mailing Address - Phone:857-991-1299
Mailing Address - Fax:
Practice Address - Street 1:53 ROUTE 130
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:MA
Practice Address - Zip Code:02644-1402
Practice Address - Country:US
Practice Address - Phone:508-477-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237573363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics