Provider Demographics
NPI:1275868762
Name:MARSHALL, BRENDA (EDD, NP)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:EDD, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 TERHUNE DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-7105
Mailing Address - Country:US
Mailing Address - Phone:973-616-5362
Mailing Address - Fax:
Practice Address - Street 1:525 WANAQUE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:POMPTON LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07442-1843
Practice Address - Country:US
Practice Address - Phone:973-685-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00207700163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult