Provider Demographics
NPI:1497003867
Name:MARSHALL, MARY ANN (RN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 NAPLES ST APT 243
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1853
Mailing Address - Country:US
Mailing Address - Phone:619-947-8200
Mailing Address - Fax:
Practice Address - Street 1:566 NAPLES ST APT 243
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1853
Practice Address - Country:US
Practice Address - Phone:619-947-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544408163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse