Provider Demographics
NPI:1629496450
Name:MARSHALL, FELICIA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:
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 1:30830 STONE RIDGE DR
Mailing Address - Street 2:APT 6116
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393-3809
Mailing Address - Country:US
Mailing Address - Phone:248-469-9395
Mailing Address - Fax:
Practice Address - Street 1:30830 STONE RIDGE DR
Practice Address - Street 2:APT 6116
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393-3809
Practice Address - Country:US
Practice Address - Phone:248-469-9395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703107551164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse