Provider Demographics
NPI:1073925319
Name:MARSHALL, MATTHEW (FNP)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SAFFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85546-4026
Mailing Address - Country:US
Mailing Address - Phone:928-428-1500
Mailing Address - Fax:928-428-1555
Practice Address - Street 1:2016 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SAFFORD
Practice Address - State:AZ
Practice Address - Zip Code:85546-4026
Practice Address - Country:US
Practice Address - Phone:928-428-1500
Practice Address - Fax:928-428-1555
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5594363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner