Provider Demographics
NPI:1184453052
Name:MARSHALL ADVANCED NURSING PRACTICE LLC
Entity type:Organization
Organization Name:MARSHALL ADVANCED NURSING PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:323-251-8983
Mailing Address - Street 1:7903 ELM AVE APT 233
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6850
Mailing Address - Country:US
Mailing Address - Phone:323-251-8983
Mailing Address - Fax:
Practice Address - Street 1:710 N EUCLID ST STE 208
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-4132
Practice Address - Country:US
Practice Address - Phone:323-251-8983
Practice Address - Fax:951-386-0266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty