Provider Demographics
NPI:1649527037
Name:MARSHALL, KRISTA (NP)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MARY DR
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1615
Mailing Address - Country:US
Mailing Address - Phone:413-262-1485
Mailing Address - Fax:
Practice Address - Street 1:155 FEDERAL ST STE 700
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-1727
Practice Address - Country:US
Practice Address - Phone:413-262-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268522363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology