Provider Demographics
NPI:1154331015
Name:MARSHALL, AMI S (APRN)
Entity type:Individual
Prefix:
First Name:AMI
Middle Name:S
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:AMI
Other - Middle Name:
Other - Last Name:REBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:530 MIDDLEBURY RD STE 103A
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2547
Mailing Address - Country:US
Mailing Address - Phone:203-527-6953
Mailing Address - Fax:203-528-4331
Practice Address - Street 1:530 MIDDLEBURY RD STE 103A
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2547
Practice Address - Country:US
Practice Address - Phone:203-527-6953
Practice Address - Fax:203-528-4331
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003111363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
500001891OtherMEDICARE
CT004247872Medicaid
CT004247872Medicaid