Provider Demographics
NPI:1932717071
Name:MARSHALL, PATRICIA (DIETITIAN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23441 WILDWOOD ST
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2424
Mailing Address - Country:US
Mailing Address - Phone:248-229-5023
Mailing Address - Fax:
Practice Address - Street 1:23441 WILDWOOD ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2424
Practice Address - Country:US
Practice Address - Phone:248-229-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education