Provider Demographics
NPI:1861171241
Name:SHULL, MARNIE MARIA (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARNIE
Middle Name:MARIA
Last Name:SHULL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5597 AISEK ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-9522
Mailing Address - Country:US
Mailing Address - Phone:907-780-3044
Mailing Address - Fax:907-780-3032
Practice Address - Street 1:5597 AISEK ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-9522
Practice Address - Country:US
Practice Address - Phone:907-780-3044
Practice Address - Fax:907-780-3032
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK140609164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse