Provider Demographics
NPI:1326937137
Name:CHISHOLM, MARLENE KING (RN)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:KING
Last Name:CHISHOLM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 CASSIDY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4306
Mailing Address - Country:US
Mailing Address - Phone:704-460-5292
Mailing Address - Fax:
Practice Address - Street 1:316 E FRANKLIN BLVD STE C-1
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7135
Practice Address - Country:US
Practice Address - Phone:980-437-4109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory