Provider Demographics
NPI:1659675791
Name:MARSHALL, STACI MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2008
Mailing Address - Country:US
Mailing Address - Phone:330-473-6615
Mailing Address - Fax:
Practice Address - Street 1:844 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2008
Practice Address - Country:US
Practice Address - Phone:330-473-6615
Practice Address - Fax:330-441-4352
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11931363L00000X
OHCOA.11931-NP363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily