Provider Demographics
NPI:1801178397
Name:MARSHALL, WENDY SUSAN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:SUSAN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4837 DANIELS RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-9619
Mailing Address - Country:US
Mailing Address - Phone:218-729-7393
Mailing Address - Fax:
Practice Address - Street 1:4837 DANIELS RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-9619
Practice Address - Country:US
Practice Address - Phone:218-729-7393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL47224-3164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse