Provider Demographics
NPI:1255849808
Name:MARSHALL, DONNETA PATRICE (FNP)
Entity Type:Individual
Prefix:
First Name:DONNETA
Middle Name:PATRICE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15735 NORDHOFF ST UNIT 14
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-3153
Mailing Address - Country:US
Mailing Address - Phone:818-935-0553
Mailing Address - Fax:
Practice Address - Street 1:9700 WOODMAN AVE STE A10
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-8040
Practice Address - Country:US
Practice Address - Phone:818-746-2626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004270363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily