Provider Demographics
NPI:1528661204
Name:MARSHALL, DAMARIS N (LPN175813MEDS-IV)
Entity type:Individual
Prefix:
First Name:DAMARIS
Middle Name:N
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPN175813MEDS-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 W 80TH ST APT 204
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1948
Mailing Address - Country:US
Mailing Address - Phone:216-387-7967
Mailing Address - Fax:
Practice Address - Street 1:1360 W 80TH ST APT 204
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1948
Practice Address - Country:US
Practice Address - Phone:216-387-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.175813.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse