Provider Demographics
NPI:1922395631
Name:MARSHALL, TERESA LYNN (CD(DONA), PCD(DONA))
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CD(DONA), PCD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9341 W 194TH TER
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:KS
Mailing Address - Zip Code:66013-9677
Mailing Address - Country:US
Mailing Address - Phone:913-271-4067
Mailing Address - Fax:
Practice Address - Street 1:9341 W 194TH TER
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:KS
Practice Address - Zip Code:66013-9677
Practice Address - Country:US
Practice Address - Phone:913-271-4067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO374J00000X174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator