Provider Demographics
NPI:1376939561
Name:MARSHALL, JACKIE SUE
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:SUE
Last Name:MARSHALL
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 1:4249 E ANDREA DR
Mailing Address - Street 2:
Mailing Address - City:CAVE CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85331-2631
Mailing Address - Country:US
Mailing Address - Phone:602-930-9568
Mailing Address - Fax:480-502-3688
Practice Address - Street 1:5734 E RANCHO MANANA BLVD
Practice Address - Street 2:STE 4
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-8513
Practice Address - Country:US
Practice Address - Phone:602-930-9568
Practice Address - Fax:480-502-3688
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator