Provider Demographics
NPI:1225468887
Name:MARSHALL, GWENDOLYN (CNA)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 REDD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-4223
Mailing Address - Country:US
Mailing Address - Phone:804-245-6837
Mailing Address - Fax:
Practice Address - Street 1:1959 REDD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-4223
Practice Address - Country:US
Practice Address - Phone:804-245-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator