Provider Demographics
NPI:1245769322
Name:AYER, MARSHALL JAMES (RN)
Entity Type:Individual
Prefix:MR
First Name:MARSHALL
Middle Name:JAMES
Last Name:AYER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:156 IL HIGHWAY 15
Mailing Address - Street 2:
Mailing Address - City:BLUFORD
Mailing Address - State:IL
Mailing Address - Zip Code:62814-3630
Mailing Address - Country:US
Mailing Address - Phone:618-734-6062
Mailing Address - Fax:
Practice Address - Street 1:156 IL HIGHWAY 15
Practice Address - Street 2:
Practice Address - City:BLUFORD
Practice Address - State:IL
Practice Address - Zip Code:62814-3630
Practice Address - Country:US
Practice Address - Phone:618-734-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.300163163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support