MEDICARE: AUDREY MARIE MARSH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1083356174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY MARIE MARSH

Provider Business Mailing Address
First Line	:	3620 42ND ST S APT 202
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-7390
Country	:	US
Telephone Number	:	701-429-1870
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 42ND ST S APT 202
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-7390
Country	:	US
Telephone Number	:	701-429-1870
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2022
Last Update Date	:	04/10/2022

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Directions to “ AUDREY MARIE MARSH ” Practice Location

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