Provider Demographics
NPI:1154494532
Name:MARSHALL, SUZAN ENTWISTLE (DO)
Entity Type:Individual
Prefix:DR
First Name:SUZAN
Middle Name:ENTWISTLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 W 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-1928
Mailing Address - Country:US
Mailing Address - Phone:509-590-6578
Mailing Address - Fax:
Practice Address - Street 1:716 W 24TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-1928
Practice Address - Country:US
Practice Address - Phone:509-590-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60083748208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery