Provider Demographics
NPI:1639652332
Name:MARSHALL, PAIGE
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:437 S BLUFF ST STE 302
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3591
Mailing Address - Country:US
Mailing Address - Phone:435-634-8848
Mailing Address - Fax:435-634-8884
Practice Address - Street 1:437 S BLUFF ST STE 302
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3591
Practice Address - Country:US
Practice Address - Phone:435-634-8848
Practice Address - Fax:435-634-8884
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV814120363LP0808X
UT5251093-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV814120OtherLICENSE
UT5251093-4405OtherLICENSE