Provider Demographics
NPI:1962789164
Name:TULL, MARSHA AM (RN)
Entity type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:AM
Last Name:TULL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 ECHO LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-3225
Mailing Address - Country:US
Mailing Address - Phone:607-656-9474
Mailing Address - Fax:
Practice Address - Street 1:12 FORT HILL PARK
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NY
Practice Address - Zip Code:13830-9998
Practice Address - Country:US
Practice Address - Phone:607-843-7185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22615197163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379597Medicaid