Provider Demographics
NPI:1548242456
Name:MARSHALL, NANCY A (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:MS #105
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-2560
Practice Address - Fax:425-899-2079
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041428208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2534ELOtherBLUE SHIELD
WA0173143OtherLABOR & INDUSTRIES
WAP00054627OtherMEDICARE RAILROAD
WA8355810Medicaid
WA8355810Medicaid
WA0173143OtherLABOR & INDUSTRIES