Provider Demographics
NPI:1386338929
Name:MARSHALL, CHRISTINA RENE (LVN)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RENE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1287 TOURMALINE AVE
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:CA
Mailing Address - Zip Code:92359-1254
Mailing Address - Country:US
Mailing Address - Phone:909-844-2405
Mailing Address - Fax:
Practice Address - Street 1:1535 W HIGHLAND AVE RM 11
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1235
Practice Address - Country:US
Practice Address - Phone:909-880-6839
Practice Address - Fax:909-880-6846
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA281142164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse