Provider Demographics
NPI:1750529053
Name:MARSHALL, REBECCA LYNNE (LMP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:LYNNE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:KEYPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98345-0793
Mailing Address - Country:US
Mailing Address - Phone:360-930-0930
Mailing Address - Fax:
Practice Address - Street 1:9100 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8389
Practice Address - Country:US
Practice Address - Phone:360-692-1178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60046344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist