Provider Demographics
NPI:1497009401
Name:MARSHALL, EDITH IHEKERENMA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:EDITH
Middle Name:IHEKERENMA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7506 GEORGIA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1608
Mailing Address - Country:US
Mailing Address - Phone:202-291-6973
Mailing Address - Fax:202-291-7018
Practice Address - Street 1:7506 GEORGIA AVENUE
Practice Address - Street 2:KBC NURSING AGENCY & HOME HEALTH CARE INC,
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012
Practice Address - Country:US
Practice Address - Phone:202-291-6973
Practice Address - Fax:202-291-7018
Is Sole Proprietor?:No
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLPN1002496164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse