Provider Demographics
NPI:1073816278
Name:MARSHALL, JONATHAN M (CRNA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 HARTLEY WAY
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-2471
Mailing Address - Country:US
Mailing Address - Phone:540-922-4236
Mailing Address - Fax:540-921-5606
Practice Address - Street 1:159 HARTLEY WAY
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134
Practice Address - Country:US
Practice Address - Phone:540-922-4236
Practice Address - Fax:540-921-5606
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173405367500000X
MERNA123033367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered