Provider Demographics
NPI:1295197069
Name:MARSHALL, SAMANTHA MARIE PERSSON (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MARIE PERSSON
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:SAMANTHA
Other - Middle Name:MARIE
Other - Last Name:PERSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:2790 GODWIN BLVD STE 375
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8175
Mailing Address - Country:US
Mailing Address - Phone:757-934-4646
Mailing Address - Fax:757-995-1944
Practice Address - Street 1:2790 GODWIN BLVD STE 375
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8175
Practice Address - Country:US
Practice Address - Phone:757-934-4646
Practice Address - Fax:757-995-1944
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily