Provider Demographics
NPI:1073310181
Name:MARSHALL, KELVINA
Entity type:Individual
Prefix:
First Name:KELVINA
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13036 OLD STAGE COACH RD APT 4217
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1614
Mailing Address - Country:US
Mailing Address - Phone:240-729-8187
Mailing Address - Fax:
Practice Address - Street 1:13036 OLD STAGE COACH RD APT 4217
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1614
Practice Address - Country:US
Practice Address - Phone:240-729-8187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant