Provider Demographics
NPI:1164404463
Name:MARSHALL, SHARON F (RN GNP CS BC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:F
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RN GNP CS BC
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:ROERICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3723 WILLOW SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-4787
Mailing Address - Country:US
Mailing Address - Phone:832-264-2133
Mailing Address - Fax:281-412-4690
Practice Address - Street 1:3723 WILLOW SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-4787
Practice Address - Country:US
Practice Address - Phone:832-264-2133
Practice Address - Fax:281-412-4690
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513451364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112662504Medicaid
TXP00041932OtherPGA RAILROAD MEDICARE
TXNP0371OtherBC/BS OF TEXAS
TXP00041932OtherPGA RAILROAD MEDICARE
TXNP0371OtherBC/BS OF TEXAS