Provider Demographics
NPI:1952012452
Name:MARSHALL, MAKENZIE (DNP, FNP-C)
Entity type:Individual
Prefix:
First Name:MAKENZIE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 CHURCHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKWELL
Mailing Address - State:NC
Mailing Address - Zip Code:28138-7736
Mailing Address - Country:US
Mailing Address - Phone:704-699-8410
Mailing Address - Fax:
Practice Address - Street 1:250 N CASWELL RD
Practice Address - Street 2:SUIT 200A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207
Practice Address - Country:US
Practice Address - Phone:704-323-2564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily