Provider Demographics
NPI:1154331015
Name:MARSHALL, AMI S (APRN)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:S
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:469 MIGEON AVE
Mailing Address - Street 2:COMMUNITY HEALTH & WELLNESS CENTER OF GREATER TORR.
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-4643
Mailing Address - Country:US
Mailing Address - Phone:860-489-0931
Mailing Address - Fax:860-489-3325
Practice Address - Street 1:YALE COMMUNITY HEALTH CARE CLINIC
Practice Address - Street 2:270 CONGRESS AVE
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06519-1403
Practice Address - Country:US
Practice Address - Phone:203-764-9959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT003111363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004247872Medicaid
071834OtherMEDICARE
CT004247872Medicaid