Provider Demographics
NPI:1346424710
Name:MARSHALL, ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WILDWOOD MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1155
Mailing Address - Country:US
Mailing Address - Phone:860-767-0168
Mailing Address - Fax:
Practice Address - Street 1:1 WILDWOOD MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1155
Practice Address - Country:US
Practice Address - Phone:860-767-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-20
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075893-11041C0700X
CT7214363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical