Provider Demographics
NPI:1093607889
Name:MARSHALL, SUSAN MARIE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N TYLER RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3725
Mailing Address - Country:US
Mailing Address - Phone:316-202-8264
Mailing Address - Fax:
Practice Address - Street 1:123 N TYLER RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-3725
Practice Address - Country:US
Practice Address - Phone:316-202-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-166707-082163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant