Provider Demographics
NPI:1902101223
Name:MARSHALL, VICTORIA E (CRNA)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:E
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:E
Other - Last Name:SHAWVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:234 GOODMAN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2364
Mailing Address - Country:US
Mailing Address - Phone:513-585-5502
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-585-5502
Practice Address - Fax:513-585-5511
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-18
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH328769163W00000X
OHCOA-12222NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100152440Medicaid
KY201016840Medicaid
OH3132578Medicaid
OHH049830Medicare PIN