Provider Demographics
NPI:1245645407
Name:MARSHALL, MARQUIETA REGINA (RN)
Entity type:Individual
Prefix:
First Name:MARQUIETA
Middle Name:REGINA
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10862 PARDEE RD
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-3554
Mailing Address - Country:US
Mailing Address - Phone:313-585-1499
Mailing Address - Fax:
Practice Address - Street 1:10862 PARDEE RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3554
Practice Address - Country:US
Practice Address - Phone:313-585-1499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704294911163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse