Provider Demographics
NPI:1609894179
Name:MARSHALL, SHERRILL G (NURSE PRACTITIONER A)
Entity Type:Individual
Prefix:
First Name:SHERRILL
Middle Name:G
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E LITTLE CREEK RD STE 205
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-4137
Mailing Address - Country:US
Mailing Address - Phone:757-587-4744
Mailing Address - Fax:757-587-4947
Practice Address - Street 1:1500 E LITTLE CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4137
Practice Address - Country:US
Practice Address - Phone:757-587-4744
Practice Address - Fax:757-587-4947
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000715364S00000X
VA0017138097363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0099999Medicaid
002291F00Medicare ID - Type Unspecified
VA0099999Medicaid