Provider Demographics
NPI:1972100493
Name:MARSHALL, BERNADETTE EUNICE (LPN)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:EUNICE
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 1:68 CAROL DR
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14215-3602
Mailing Address - Country:US
Mailing Address - Phone:337-292-4903
Mailing Address - Fax:
Practice Address - Street 1:68 CAROL DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14215-3602
Practice Address - Country:US
Practice Address - Phone:337-292-4903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338156-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse