MEDICARE: MARSHALL ADVANCED NURSING PRACTICE PC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1184453052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL ADVANCED NURSING PRACTICE PC

Provider Business Mailing Address
First Line	:	3200 E GUASTI RD
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-8660
Country	:	US
Telephone Number	:	909-755-6610
Fax Number	:	909-385-3335

Provider Business Practice Location Address
First Line	:	3200 E GUASTI RD
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91761-8660
Country	:	US
Telephone Number	:	909-755-6610
Fax Number	:	909-385-3335

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHAEL MARSHALL
Credential	:	PMHNP
Telephone Number	:	909-755-6610

Provider Enumeration Date	:	07/30/2024
Last Update Date	:	02/24/2026

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