Provider Demographics
NPI:1275205759
Name:MARSHALL, MEREDITH ANN (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13425 HOOVER CREEK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-0170
Practice Address - Country:US
Practice Address - Phone:704-316-2080
Practice Address - Fax:704-316-2085
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015146363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5015146OtherNORTH CAROLINA NURSE PRACTITIONER LICENSE