Provider Demographics
NPI:1780729749
Name:MARSHALL, ELIZABETH (AP RN BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:AP RN BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9305
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-0305
Mailing Address - Country:US
Mailing Address - Phone:304-767-7820
Mailing Address - Fax:304-767-7829
Practice Address - Street 1:4607 MACCORKLE AVE SW
Practice Address - Street 2:SUITE 305
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-767-7820
Practice Address - Fax:304-767-7829
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27343363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health