Provider Demographics
NPI:1659818557
Name:FEATHERSTONE, MARSHA (LPN 162876)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:FEATHERSTONE
Suffix:
Gender:F
Credentials:LPN 162876
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 CORNELL ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-2236
Mailing Address - Country:US
Mailing Address - Phone:330-907-0246
Mailing Address - Fax:
Practice Address - Street 1:422 CORNELL ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2236
Practice Address - Country:US
Practice Address - Phone:330-907-0246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162876164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNAMedicaid