Provider Demographics
NPI:1578897666
Name:MARSHALL, TINA M (NP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:COMPARIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSING
Mailing Address - Street 1:N10565 GRANDVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-9622
Mailing Address - Country:US
Mailing Address - Phone:906-932-1500
Mailing Address - Fax:906-932-5630
Practice Address - Street 1:N10565 GRANDVIEW LN
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9622
Practice Address - Country:US
Practice Address - Phone:906-932-1500
Practice Address - Fax:906-932-5630
Is Sole Proprietor?:No
Enumeration Date:2009-09-23
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704201827363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIAPPLIEDMedicaid
MIAPPLIEDMedicare PIN