Provider Demographics
NPI:1093229668
Name:MARSHALL, DANIELLE M (LBS)
Entity type:Individual
Prefix:MISS
First Name:DANIELLE
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 W VINE ST APT A2
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:PA
Mailing Address - Zip Code:19464-6824
Mailing Address - Country:US
Mailing Address - Phone:610-574-3925
Mailing Address - Fax:
Practice Address - Street 1:11 W VINE ST APT A2
Practice Address - Street 2:
Practice Address - City:STOWE
Practice Address - State:PA
Practice Address - Zip Code:19464-6824
Practice Address - Country:US
Practice Address - Phone:610-574-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-19
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty