Provider Demographics
NPI:1194217646
Name:MARSHALL, TRINITY LAURYL
Entity Type:Individual
Prefix:MS
First Name:TRINITY
Middle Name:LAURYL
Last Name:MARSHALL
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 1:438 PARK RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2532
Mailing Address - Country:US
Mailing Address - Phone:202-590-8709
Mailing Address - Fax:202-526-8060
Practice Address - Street 1:635 EDGEWOOD ST NE APT 718
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-4133
Practice Address - Country:US
Practice Address - Phone:202-677-9657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4291620OtherNON-DRIVERS ID