Provider Demographics
NPI:1851837900
Name:MARSHALL, COLLEEN L (CRNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:L
Other - Last Name:CIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-547-6108
Mailing Address - Fax:717-547-6189
Practice Address - Street 1:4510 MARKETPLACE WAY
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-2462
Practice Address - Country:US
Practice Address - Phone:717-547-6108
Practice Address - Fax:717-547-6189
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017245363LF0000X
PAPENIDNG363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103275985Medicaid
PA568697Medicare PIN