Provider Demographics
NPI:1811275241
Name:MARSHALL, MICAH NICOLE (APRN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:MICAH
Middle Name:NICOLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APRN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1200 N PHILLIPS AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4600
Mailing Address - Country:US
Mailing Address - Phone:405-417-1801
Mailing Address - Fax:405-271-7866
Practice Address - Street 1:1200 N PHILLIPS AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-417-1801
Practice Address - Fax:405-271-7866
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK89509363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics