Provider Demographics
NPI:1407829997
Name:ASHURST, MARSHA J (PH,D; APRN)
Entity type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:J
Last Name:ASHURST
Suffix:
Gender:F
Credentials:PH,D; APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W LYNETTE DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1028
Mailing Address - Country:US
Mailing Address - Phone:928-522-4037
Mailing Address - Fax:
Practice Address - Street 1:2700 W LYNETTE DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1028
Practice Address - Country:US
Practice Address - Phone:928-522-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN 059777363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ76270Medicare ID - Type UnspecifiedMEDICARE ID NUMBER