Provider Demographics
NPI:1720702780
Name:MARSZALKOWSKI, CARLA (RN)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MARSZALKOWSKI
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 1:1031 SHANNON AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-6775
Mailing Address - Country:US
Mailing Address - Phone:330-933-6190
Mailing Address - Fax:
Practice Address - Street 1:104 3RD ST NW STE 208
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-8223
Practice Address - Country:US
Practice Address - Phone:330-933-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH478662251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7719473Medicaid