Provider Demographics
NPI:1669839841
Name:MARSHALL, NICOLE ALEXANDRA (LMP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ALEXANDRA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ALEXANDRA
Other - Last Name:LIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9900 12TH AVE W
Mailing Address - Street 2:I104
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-1133
Mailing Address - Country:US
Mailing Address - Phone:425-772-4438
Mailing Address - Fax:
Practice Address - Street 1:9900 12TH AVE W
Practice Address - Street 2:I104
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-1133
Practice Address - Country:US
Practice Address - Phone:425-772-4438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60629028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist