Provider Demographics
NPI:1598059065
Name:MANSELL, MARSHA NOR PASCUAL (NP)
Entity Type:Individual
Prefix:
First Name:MARSHA NOR
Middle Name:PASCUAL
Last Name:MANSELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 CHESAPEAKE SQUARE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2134
Mailing Address - Country:US
Mailing Address - Phone:757-983-5100
Mailing Address - Fax:757-673-8292
Practice Address - Street 1:4124 CHESAPEAKE SQUARE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2134
Practice Address - Country:US
Practice Address - Phone:757-983-5100
Practice Address - Fax:757-673-8292
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139401363LF0000X
VA0024169317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL154152Medicaid
AL154152Medicaid