Provider Demographics
NPI:1699118893
Name:MARSHALL, CHRISTINE ANNE (LPN)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108
Mailing Address - Country:US
Mailing Address - Phone:315-720-0852
Mailing Address - Fax:949-607-3419
Practice Address - Street 1:1604 WEST HIGH TERRACE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219
Practice Address - Country:US
Practice Address - Phone:315-345-9777
Practice Address - Fax:949-607-3419
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257499164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse