Provider Demographics
NPI:1801117619
Name:MARSHALL, QUINNECIA TANIE
Entity type:Individual
Prefix:
First Name:QUINNECIA
Middle Name:TANIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 W BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-2901
Mailing Address - Country:US
Mailing Address - Phone:937-520-4473
Mailing Address - Fax:937-274-5079
Practice Address - Street 1:24 W BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-2901
Practice Address - Country:US
Practice Address - Phone:937-520-4473
Practice Address - Fax:937-274-5079
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 139192-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse