Provider Demographics
NPI:1336656594
Name:MARSH, SHAWNA JUNE
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:JUNE
Last Name:MARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 WEBSTER RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1125
Mailing Address - Country:US
Mailing Address - Phone:304-872-6503
Mailing Address - Fax:
Practice Address - Street 1:804 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1796
Practice Address - Country:US
Practice Address - Phone:304-872-2090
Practice Address - Fax:304-872-3590
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1427426329Medicaid