Provider Demographics
NPI:1538378492
Name:MARSHALL, PAULETTA ANN (RN)
Entity type:Individual
Prefix:
First Name:PAULETTA
Middle Name:ANN
Last Name:MARSHALL
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 1:505 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-9063
Mailing Address - Country:US
Mailing Address - Phone:937-488-1007
Mailing Address - Fax:
Practice Address - Street 1:505 MOUND RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-9063
Practice Address - Country:US
Practice Address - Phone:937-488-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH299356163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2508816Medicare UPIN