Provider Demographics
NPI:1093143836
Name:CARROLL, MARSHA WREN (APRN)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:WREN
Last Name:CARROLL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 WREN ST
Mailing Address - Street 2:
Mailing Address - City:BARNWELL
Mailing Address - State:SC
Mailing Address - Zip Code:29812-1529
Mailing Address - Country:US
Mailing Address - Phone:803-259-5762
Mailing Address - Fax:803-259-3250
Practice Address - Street 1:86 WREN ST
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1529
Practice Address - Country:US
Practice Address - Phone:803-259-5762
Practice Address - Fax:803-259-3250
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18476363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3939Medicaid
SC18476OtherMEDICAL LICENSE
SCNP3939Medicaid
SCRHC004Medicaid
SC105031Medicaid
SCL00061Medicaid