Provider Demographics
NPI:1083824759
Name:MARSHALL, MICHELE LYNN (RN, CNS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 OWENS ROAD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45359
Mailing Address - Country:US
Mailing Address - Phone:937-676-3954
Mailing Address - Fax:
Practice Address - Street 1:2222 PHILADELPHIA DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1813
Practice Address - Country:US
Practice Address - Phone:937-278-2612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNS-06041364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist