Provider Demographics
NPI:1992238174
Name:STALLING, MARQUISHA
Entity type:Individual
Prefix:
First Name:MARQUISHA
Middle Name:
Last Name:STALLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 E AVENUE J
Mailing Address - Street 2:UNIT B
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-2517
Mailing Address - Country:US
Mailing Address - Phone:972-697-9082
Mailing Address - Fax:
Practice Address - Street 1:506 E AVENUE J
Practice Address - Street 2:UNIT B
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-2517
Practice Address - Country:US
Practice Address - Phone:972-697-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175M00000XOther Service ProvidersMidwife, Lay