Provider Demographics
NPI:1386950525
Name:MARSHALL, ROSANNA MARIE (MACOM)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:MARIE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 SW 150TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-4612
Mailing Address - Country:US
Mailing Address - Phone:646-573-0429
Mailing Address - Fax:
Practice Address - Street 1:652 SW 150TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-4612
Practice Address - Country:US
Practice Address - Phone:206-494-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60119132171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist