Provider Demographics
NPI:1073751160
Name:MARSHALL, PENNIE KATHALEEN (LPN)
Entity Type:Individual
Prefix:
First Name:PENNIE
Middle Name:KATHALEEN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9441 CREEK VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48622
Mailing Address - Country:US
Mailing Address - Phone:989-588-0301
Mailing Address - Fax:
Practice Address - Street 1:9441 CREEK VIEW DR
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:MI
Practice Address - Zip Code:48622-8452
Practice Address - Country:US
Practice Address - Phone:989-588-0301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703099359164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse