Healthcare Provider Details

I. General information

NPI: 1902957434
Provider Name (Legal Business Name): CHERYL LYNN MARSHALL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 E GUADALUPE RD
TEMPE AZ
85283
US

IV. Provider business mailing address

1006 E GUADALUPE RD
TEMPE AZ
85283-3047
US

V. Phone/Fax

Practice location:
  • Phone: 480-838-4296
  • Fax: 480-820-1275
Mailing address:
  • Phone: 480-838-4296
  • Fax: 480-820-1275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2839
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: