Provider Demographics
NPI:1366438202
Name:MARSHALL, WANDA M (ARNP)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:M
Other - Last Name:BORCHARDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 YOSEMITE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6074
Mailing Address - Country:US
Mailing Address - Phone:303-602-8968
Mailing Address - Fax:303-602-8956
Practice Address - Street 1:1001 YOSEMITE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6074
Practice Address - Country:US
Practice Address - Phone:303-602-8968
Practice Address - Fax:303-602-8956
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAC063535363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0452649Medicaid
IA0452649Medicaid
I8851Medicare ID - Type Unspecified