Provider Demographics
NPI:1184493991
Name:MARSHALL, LEGACYY NASTASSIA (CNA)
Entity type:Individual
Prefix:
First Name:LEGACYY
Middle Name:NASTASSIA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3782 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-2636
Mailing Address - Country:US
Mailing Address - Phone:216-467-5091
Mailing Address - Fax:
Practice Address - Street 1:9807 DENISON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-4630
Practice Address - Country:US
Practice Address - Phone:216-467-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide