Provider Demographics
NPI:1871684043
Name:MARSHALL, DIANA M (APRN)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERKINS SQ
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-1063
Mailing Address - Country:US
Mailing Address - Phone:330-543-8590
Mailing Address - Fax:330-543-3856
Practice Address - Street 1:1 PERKINS SQ
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44308-1063
Practice Address - Country:US
Practice Address - Phone:330-543-8590
Practice Address - Fax:330-543-3856
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.00284-NS364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000359452OtherANTHEM
OHNS02326Medicare ID - Type Unspecified
OHP74443Medicare UPIN
OHNS02323Medicare ID - Type Unspecified
OHNS02325Medicare ID - Type Unspecified
OHNS02324Medicare ID - Type Unspecified