Provider Demographics
NPI:1811619125
Name:MARSHALL, SHAWNTAE KATRINA
Entity type:Individual
Prefix:
First Name:SHAWNTAE
Middle Name:KATRINA
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 1:2606 18TH ST SE APT C
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3259
Mailing Address - Country:US
Mailing Address - Phone:706-621-0469
Mailing Address - Fax:
Practice Address - Street 1:2606 18TH ST SE APT H
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3211
Practice Address - Country:US
Practice Address - Phone:571-533-4586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2658333OtherCPR AED & BASIC FIRST AIDE