Provider Demographics
NPI:1508607789
Name:MARSHALL, KATIE (APRN, CNM)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:HOFFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1614 E NORRIS DR
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-3681
Mailing Address - Country:US
Mailing Address - Phone:815-431-0435
Mailing Address - Fax:815-431-0443
Practice Address - Street 1:1614 E NORRIS DR
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-3681
Practice Address - Country:US
Practice Address - Phone:815-431-0435
Practice Address - Fax:815-431-0443
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029762367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife