Provider Demographics
NPI:1083053011
Name:MARSHALL, BETTY J (NP)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:J
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 S VAN BUREN RD
Mailing Address - Street 2:STE 2
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5033
Mailing Address - Country:US
Mailing Address - Phone:336-635-6806
Mailing Address - Fax:
Practice Address - Street 1:518 S VAN BUREN RD
Practice Address - Street 2:STE 2
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5033
Practice Address - Country:US
Practice Address - Phone:336-635-6806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00427500363LA2200X
PASP012834363LA2200X
NC5008173363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health