Provider Demographics
NPI:1902957434
Name:MARSHALL, CHERYL LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 E GUADALUPE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3047
Mailing Address - Country:US
Mailing Address - Phone:480-838-4296
Mailing Address - Fax:480-820-1275
Practice Address - Street 1:1006 E GUADALUPE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283
Practice Address - Country:US
Practice Address - Phone:480-838-4296
Practice Address - Fax:480-820-1275
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2839363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical