Provider Demographics
NPI:1336633874
Name:MARSHALL, TASHEMIA (LVN)
Entity Type:Individual
Prefix:MRS
First Name:TASHEMIA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:TASHEMIA
Other - Middle Name:
Other - Last Name:RILEY-MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:2410 W 78TH ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1120
Mailing Address - Country:US
Mailing Address - Phone:310-922-8650
Mailing Address - Fax:
Practice Address - Street 1:2501 W EL SEGUNDO BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3317
Practice Address - Country:US
Practice Address - Phone:323-754-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261961164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse