Provider Demographics
NPI:1407132699
Name:MARSHALL, JEAN R
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:R
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 1:2904 HORNED OWL WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-2470
Mailing Address - Country:US
Mailing Address - Phone:702-321-6576
Mailing Address - Fax:702-804-9479
Practice Address - Street 1:2904 HORNED OWL WAY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89084-2470
Practice Address - Country:US
Practice Address - Phone:702-321-6576
Practice Address - Fax:702-804-9479
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner