Provider Demographics
NPI:1114416302
Name:MARSHALL-KING, SANDRA DEAN
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:DEAN
Last Name:MARSHALL-KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11831
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40251-0831
Mailing Address - Country:US
Mailing Address - Phone:502-709-5600
Mailing Address - Fax:502-709-5600
Practice Address - Street 1:2900 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1251
Practice Address - Country:US
Practice Address - Phone:502-709-5600
Practice Address - Fax:502-709-5600
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator