Provider Demographics
NPI:1932357639
Name:KENTISH, MARSHA DAMARIS (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:DAMARIS
Last Name:KENTISH
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 1:2509 GEORGE MASON DR UNIT 6973
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1741
Mailing Address - Country:US
Mailing Address - Phone:757-404-6078
Mailing Address - Fax:757-282-2696
Practice Address - Street 1:3600 BRANNON DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-6908
Practice Address - Country:US
Practice Address - Phone:757-404-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-05
Last Update Date:2022-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001151757163WC0400X, 171M00000X, 251B00000X
171M00000X, 174H00000X, 133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No174H00000XOther Service ProvidersHealth Educator
No251B00000XAgenciesCase Management