Provider Demographics
NPI:1669689584
Name:MARSHALL, JULIE R (RN, APN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RN, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6636 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561
Mailing Address - Country:US
Mailing Address - Phone:630-863-3754
Mailing Address - Fax:630-789-9093
Practice Address - Street 1:6636 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561
Practice Address - Country:US
Practice Address - Phone:630-863-3754
Practice Address - Fax:630-789-9093
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2019-08-07
Deactivation Date:2019-07-27
Deactivation Code:
Reactivation Date:2019-08-07
Provider Licenses
StateLicense IDTaxonomies
IL041-190862163W00000X
WI9387-33363LP2300X
IL209-005927364S00000X
IL209.018852363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1316998578OtherGROUP PRACTICE NPI