Provider Demographics
NPI:1124073713
Name:STUCKY-MARSHALL, LISA (APN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STUCKY-MARSHALL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 E BRUSH HILL RD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5658
Mailing Address - Country:US
Mailing Address - Phone:331-221-2161
Mailing Address - Fax:331-221-3857
Practice Address - Street 1:177 E BRUSH HILL RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:331-221-2161
Practice Address - Fax:331-221-3857
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-002340364SX0200X
IL209002340363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncology